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Registration Form

Service Users Agreement
By compleating and sending a Registration Form (below) to Speak Out Scotland, I agree to the following statements:

  1. I am a male survivor of childhood sexual abuse.
  2. I have not committed or been convicted of a sexual offence.
  3. I will treat volunteers, staff, management and other service users with respect at all times.
  4. I will not use racist, sectarian or homophobic language.
  5. I will respect the confidentiality of other service users and treat all conversations with other service users as confidential.
  6. I will not engage in aggressive or threatening behaviour at any time when using Speak out Scotland services.
  7. I will be free of alcohol or drugs (excluding prescribed drugs) while using any Speak Out Scotland services.
  8. I will not take any alcohol or drugs into any Speak Out Scotland services.
  9. I will not carry anything that can be deemed to be a weapon whilst using Speak Out Scotland services.
  10. I agree that Speak Out Scotland can hold my name and contact details on their confidential database.
  11. I agree that if I break any part of this agreement I will no longer be able to use Speak Out Scotland services.

Speak Out Scotland’s core management team includes complex trauma experts and CSA survivors, coming from both sides of the therapy room they have devised a model of recovery that is innovative in its belief that the client is the expert, unique in its understanding of the continuously evolving needs of male survivors. Through our experiences, we know that the journey to recovery needs specialist, ongoing support. We know that many men endure mental and physical health issues and lead dysfunctional lives, the journey to recovery is difficult each individuals CSA experiences are unique to them, recovery takes time and sometimes involves new beginnings, however, your journey starts here. Call, email or and send the registration form, we will support you. We are continuing o build a continuously evolving service that supports men in a variety of different ways according to need.

Services we provide: Complex Trauma Therapy, Advocacy, Support Group and  Signposting (to other appropriate services) Free CSA related Books.

We pledge to treat all service users with respect and confidentiality, regardless of ethnicity, sexuality or age.  

Your Name *

Date of Birth *

Your Address * ( we will never send mail without your permission)



Your Postcode *

Permission to send mail

Tel Number * (at least one number is required)
Home:
messages can be left
Work:
messages can be left
Mobile:
messages can be left

Your Email (optional)
Permission to send email

GP Information

GP Name *

GP Address *



GP Postcode

GP Tel Number *

I have read, understood and accepted the Speak Out Scotland service users agreement.

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