NHS Registration Form (for organisations paying by purchase order number)

If you are a NHS Organisation wishing to use WEMWBS you can purchase an annual licence online (for up to 30,000 Participants).

Please note that this form is for NHS organisations only, if your email address does not contain NHS in the suffix you need to apply using the main commercial licence application form.

Please complete the form below to register and pay for your licence, ensuring that you read and accept the terms and conditions.

If you wish to offer WEMWBS to a greater number of Participants we would be happy to discuss your requirements. Please contact us at to discuss your requirements.

{"elements":[{"isDiscrete":false,"hidden":false,"name":"1765960158769_0.22704485153899545_0.604563479059629","readOnly":false,"id":644384950,"type":"commentElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"Survey","value":"0-survey"},{"text":"Cohort study","value":"1-cohortstudy"},{"text":"Evaluation of service, intervention or approach","value":"2-evaluationofserviceinterventionorapproach"},{"text":"Controlled trial","value":"3-controlledtrial"},{"text":"Randomised controlled trial","value":"4-randomisedcontrolledtrial"},{"text":"As part of a product or service provision","value":"5-aspartofaproductorserviceprovision"},{"text":"Other","value":"6-other"}],"name":"Type of Use","readOnly":false,"id":644384951,"type":"listElement"},{"isDiscrete":false,"hidden":false,"name":"type of use other","readOnly":false,"id":644384952,"type":"textBoxElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"Mental health promotion/mental health education eg mental health literacy, school based programmes","value":"0-mentalhealthpromotionmentalhealtheducationegmentalhealthliteracyschoolbasedprogrammes"},{"text":"Psychological therapy","value":"1-psychologicaltherapy"},{"text":"Group based mental health support \u2013 eg in high risk groups","value":"2-groupbasedmentalhealthsupporteginhighriskgroups"},{"text":"Health behaviour or lifestyle programmes including physical activity","value":"3-healthbehaviourorlifestyleprogrammesincludingphysicalactivity"},{"text":"Workplace wellbeing provison","value":"4-workplacewellbeingprovison"},{"text":"Engagement in arts or music","value":"5-engagementinartsormusic"},{"text":"Engagement in or creation of natural environments","value":"6-engagementinorcreationofnaturalenvironments"},{"text":"Community and social support programmes","value":"7-communityandsocialsupportprogrammes"},{"text":"Parenting programmes","value":"8-parentingprogrammes"},{"text":"Mindfulness programmes","value":"9-mindfulnessprogrammes"},{"text":"Mindful movement programmes eg Yoga, Tai Chi, Alexander Technique","value":"10-mindfulmovementprogrammesegyogataichialexandertechnique"},{"text":"Multicomponent","value":"11-multicomponent"},{"text":"Other (eg routine NHS provision; other service provision)","value":"12-otheregroutinenhsprovisionotherserviceprovision"}],"name":"type of intervention","readOnly":false,"id":644384953,"type":"checkboxElement"},{"isDiscrete":false,"hidden":false,"name":"intervention type other","readOnly":false,"id":644384954,"type":"textBoxElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"Community","value":"0-community"},{"text":"NHS","value":"1-nhs"},{"text":"School(s)","value":"2-schools"},{"text":"Workplace or occupational setting","value":"3-workplaceoroccupationalsetting"},{"text":"Social services (including care home setting)","value":"4-socialservicesincludingcarehomesetting"},{"text":"University or college","value":"5-universityorcollege"},{"text":"Other","value":"6-other"}],"name":"field of use","readOnly":false,"id":644384955,"type":"checkboxElement"},{"isDiscrete":false,"hidden":false,"name":"field of use other","readOnly":false,"id":644384956,"type":"textBoxElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"WEMWBS - 14 item scale","value":"0-wemwbs14itemscale"},{"text":"SWEMWBS - Shortened 7 item scale","value":"1-swemwbsshortened7itemscale"}],"name":"WEMWBS version","readOnly":false,"id":644384957,"type":"listElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"11-17","value":"0-1117"},{"text":"18-64","value":"1-1864"},{"text":"65+","value":"2-65"}],"name":"participant age","readOnly":false,"id":644384958,"type":"checkboxElement"},{"isDiscrete":false,"hidden":false,"name":"License Start","readOnly":false,"id":644384959,"type":"dateTimeElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"----","value":"----"},{"text":"Up to 50 Participants - Annual Licence Fee: £75","value":"75"},{"text":"Up to 100 Particpants - Annual Licence Fee: £125","value":"125"},{"text":"Up to 250 Participants - Annual Licence Fee: £250","value":"250"},{"text":"Up to 500 Participants - Annual Licence Fee: £375","value":"375"},{"text":"Up to 1000 Participants - Annual Licence Fee: £600","value":"600"},{"text":"Up to 3000 Participants - Annual Licence Fee: £1125","value":"1125"},{"text":"Up to 5000 Participants - Annual Licence Fee: £1375","value":"1375"},{"text":"Up to 10,000 Participants - Annual Licence Fee: £1875","value":"1875"},{"text":"Up to 15,000 Participants - Annual Licence Fee: £2250","value":"2250"},{"text":"Up to 20,000 Participants - Annual Licence Fee: £2625","value":"2625"},{"text":"Up to 30,000 Participants - Annual Licence Fee: £3000","value":"3000"},{"text":"Test internal use","value":"1"}],"name":"Scale of use","readOnly":false,"id":644384960,"type":"paymentElement"},{"isDiscrete":false,"hidden":false,"name":"Organisation Details","readOnly":false,"id":644385149,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Address line 1","readOnly":false,"id":644385166,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Address line 2","readOnly":false,"id":644385167,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Town or city","readOnly":false,"id":644385168,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"County","readOnly":false,"id":644385169,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Postcode","readOnly":false,"id":644385170,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Country","readOnly":false,"id":644385171,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Accounts address (if different)","readOnly":false,"id":644385223,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Accounts address line 1","readOnly":false,"id":644385228,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Accounts address Line 2","readOnly":false,"id":644385533,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Accounts Post Code","readOnly":false,"id":644385244,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Accounts Country","readOnly":false,"id":644385259,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Accounts email address","readOnly":false,"id":644385262,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Accounts Telephone Number (Required)","readOnly":false,"id":644385268,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Purchaser Name","readOnly":false,"id":644385271,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Purchaser Title","readOnly":false,"id":644385273,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Purchaser Email address","readOnly":false,"id":644385275,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Purchaser Telephone Number","readOnly":false,"id":644385294,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Purchase Order Number (Required)","readOnly":false,"id":644385567,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"VAT Registration number (if applicable)","readOnly":false,"id":644385278,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"No of employees in your organisation","readOnly":false,"id":644385296,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"1766050876364_0.8849149155062436_0.08420154859631479","readOnly":false,"id":644384962,"type":"commentElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"Yes","value":"0-yes"}],"name":"terms conditions acceptance","readOnly":false,"id":644384961,"type":"checkboxElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"Yes","value":"0-yes"},{"text":"No","value":"1-no"}],"name":"Contact details permission","readOnly":false,"id":644384963,"type":"checkboxElement"}]}

How are you planning to use WEMWBS?

Type of Use

If other, please specify

Community

NHS

School(s)

Workplace or occupational setting

Social services (including care home setting)

University or college

Other

If other, please specify

Preferred version of WEMWBS
(Note – both versions of WEMWBS can be used under a single licence)

11-17

18-64

65+

Start Date (Note – the Annual License Period is 12 (twelve) months from the Start Date)

Scale of Use: Please select the licence you require based on the total number of individuals you will make WEMWBS available to (Participants) during the Annual Licence Period

Organisation Name (in full)

Address line 1

Address line 2

Town or city

County

Postcode

Country

Accounts address (if different)

Accounts address line 1

Accounts address Line 2

Accounts Post Code

Accounts Country

Accounts email address

Accounts Telephone Number (Required)

Purchaser Name

Purchaser Title

Purchaser Email address

Purchaser Telephone Number (Required)

Purchase Order Number (Required)

VAT Registration number (if applicable)

No of employees in your organisation (If unsure please estimate)

NHS Terms and Conditions

Yes

Privacy notice

The University of Warwick will process your personal data, being your contact details for the purpose(s) of licence registration, management and academic research

The legal basis for processing this personal data is that it is necessary for the performance of a contract and a public task

Your personal data will not be shared or disclosed to any third parties external to the University of Warwick, unless you have ticked yes to the box above, at which point we will share your personal data with third parties for the purposes of product development of WEMWBS.

Your personal data will not be transferred outside of the EEA, will be kept securely by the University of Warwick and will be retained for up to 5 years and used for licence management and academic research.

The University of Warwick is the Data Controller of any information you have entered on this form and is committed to protecting the rights of individuals in line with Data Protection Legislation. The University's Data Protection webpages provide further information on your rights and how the University processes personal data. If you wish to submit a data subjects rights request, make a complaint or report a suspected personal data breach, please contact the University’s Data Protection Officer by email at infocompliance@warwick.ac.uk.

Spam prevention

Warwick Innovations

NHS Registration Form (for organisations paying by purchase order number)

How are you planning to use WEMWBS?

Failure to load reCAPTCHA