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NAMI Glendale BASICS Class Application
Register for the FREE, six-session program designed for parents and other family caregivers of children and adolescents who are exhibiting symptoms or diagnosed with a mental illness.
Email Address *
Last Name *
First Name *
Address *
City *
Zip *
Phone Number *
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 loved one with illness *
Relationship to you *
Age *
Clear selection
Age of illness onset *
Diagnosis if known or symptoms *
Medications used (if unknown-write unknown) *
Living arrangements *
Other information
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