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NAMI SGV Family to Family Class
Registration for our FREE 8- session Family to Family educational program.
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Email
*
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Last Name
*
Your answer
First Name
*
Your answer
Address
*
Your answer
City
*
Your answer
Zip Code
*
Your answer
Phone Number
*
Your answer
Preferred Language
English
Spanish
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Please share something about your loved one who is living with a mental health illness. This information will be used to help to determine if this program meets your needs.
Name of your family member living with a mental illness
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Relationship to you
*
Your answer
Age
*
Your answer
Gender
Female
Male
Prefer not to say
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Age of illness onset
*
Your answer
Diagnosis (if diagnosed) or symptoms-*Note* only applicants who provide their loved one's diagnosis or symptoms are admitted to the class. *
*
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Medications used
*
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Living arrangements
*
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Other information
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