Therapeutic Services

University of Sussex
Therapeutic Services
Student Registration Forms
WARNING: If this is an emergency, please call 999 or the Mental Health Rapid Response Service on 0300 304 0078

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Please enter your personal information below.
Note that any required fields are indicated by * (asterisk)
*First Name:
Middle Name:
*Last Name:
Preferred Name:
Pronouns:
*Date of birth	(mm/dd/yyyy format)
*Student Registration Number: (This is an EIGHT DIGIT number found on your student card and starts with a 21 or 22)
*Mobile phone:
Home Phone:	OK to phone?YesNo
Other Phone:
*Please enter your Sussex email address here
*Local Address:
OK to contact at Local Address:	YesNo
*Permanent Address:
OK to contact at Permanent Address:	YesNo

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Please notify the front desk staff so they can delete your previous session if necessary.