contact me,

Contact Me.

Depression, Anxiety, Panic, The Three Brothers,

Thank you for taking the time to Contact Me.
Your comments and feedback will help guide the future development of this Site.

I have included a small survey into this page. If you have time to tick the boxes I will appreciate your input.

Thank You. Graeme

As you have already read, this Web Site is an account of what actually happened to me when I was hit by the ravagers of the Three Brothers; Depression, Anxiety and Panic and the self-help tools I used to get myself back on track.

I have experienced a profound solitude in writing and building this Site.

If someone who is carrying the stigma of Depression or Anxiety reads this Web Site learns and understands that they are okay and there is nothing to be ashamed of, they will break free.

When that happens and they escape the stigma, this Web Site will have achieved something worthwhile.

No personal information from this page is shared with anyone. All contact details associated with the use of this Form are striped away by filters and other management proceedures. If you would like a reply from me you need to tell me and include your contact details within the body of the Form.

If you wish to ask me a question I will answer with an honest reply.
If I do not know the answer I will tell you I do not know. I will however try to find an answer or a link to another web site that may be able to help and I will tell you what I find.

Please note that all fields followed by an asterisk must be filled in.

First Name*
First Name*

E-mail Address

Street Address

City*
City*

State/Prov*
State/Prov*

Zip/Postal Code*
Zip/Postal Code*

Country*
Country*

Home Phone

Business Phone

Your Comments Please*
Your Comments Please*

Would You Like Me to Respond to your Comment ?*
Would You Like Me to Respond to your Comment ?*

	Yes Please
	No Thank You

Please Check and Confirm Your Contact Details Are Correct ?*
Please Check and Confirm Your Contact Details Are Correct ?*

Yes

The following portion of this form is a simple survey to help guide the future direction of my site. If you do not feel comfortable answering any section Please leave it unanswered. I thank you for any assistance or comments.

	Male
	Female

Age

	under 25
	25 to 35
	35 to 45
	45 to 55
	55 to 65
	65 to 75
	over 75

How Did You Learn about My Site?

Are You Suffering With Any of the Following Symptoms;

	Depression.
	Anxiety.
	Panic attacks.
	Sexual Dysfunction.
	Self-conscious or ashamed.
	Anger.

Other

Home Environment;

	Family Group.
	I have a Partner.
	I am doing this Alone.
	Sharing a home with friends.

I Am Rebuilding My Life With The Care & Help From;

	A Very Special Friend
	Therapist
	Physician
	Psychologist(or similar)
	I am Doing it alone

Other

I Find The Following Can Encourage Me To Feel Better Within Myself;

	Meditation
	Exercise
	Morning or Afternoon Walks
	Aromatherapy
	Reading
	Being with Friends
	Quiet Times with Myself

Other

Thank You for your contact. Please feel free to add additional comments.

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