Getting to Know You

Before your 121 Telephone Support call appointment, it is helpful to know a little bit about you. I would appreciate it if you could complete this form as soon as possible.

If you haven’t yet done so, you can now book your appointment in our online booking system.

Please note: The information you share is confidential and is removed from our system as soon as our 121 Telephone Support call has been completed.

  • Date Format: MM slash DD slash YYYY
  • For example smoking, alcohol, prescription drugs
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