VBI Support Group Application Form
About us: 
• The Voices of Brain Injury Support Group aims to provide a safe and inclusive space for those in the brain injury community to connect with others and share your recovery journey
• Meet with and support other individuals with similar injuries and symptoms
• Share your experience and learn from other individuals journeys

The format:
• Peer-led meetings (~1 hour long) using an online video platform
• An online support chat channel to share resources and connect with others in the community
• The sessions will be largely discussion based with questions to guide conservations

Upcoming dates, all at 5:00pm EST (2:00pm PST): May 18, June 1, June 22, July 6

Link to Consent & Confidentiality Agreement; please sign and email to VBIcareteam@gmail.com:



We will review your application and reach out to you with more information. If you require support filling out the form, please email VBIcareteam@gmail.com. We offer personalized support to best address an individual's unique accessibility needs; some examples include:

• Phone/video support to walk people through the form or complete it together.
• Video instructions for those who prefer step-by-step guidance.
• Voice memos as an alternative to typing responses.
• To share the information through email rather than complete the online form
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What is your name and preferred pronouns (i.e. she/her)? *
Please provide your email address: *
Please provide the information of an emergency contact (Name, relationship, email, phone number) *
The following questions are optional
OPTIONAL: Do you have any concerns with accessibility or is there anything we should be aware of in order to best support you (i.e. symptoms, sensitive topics, triggers)?
OPTIONAL: What do you hope to get out of the group? Are there any topics that you would like to focus on (i.e. trouble sleeping, transitioning back to work)
OPTIONAL: We are excited to meet with you! Do you have any questions or comments?
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