Welcome to Epilepsy Toronto

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Epilepsy Toronto offers support services to people living with epilepsy, other seizure disorders, their family members, those who care for them and work with them.

This form helps us understand your needs so we can connect you with the most suitable supports for your situation. Depending on your area, waitlists, and specific needs, you may be redirected to a closer epilepsy agency. If there is a program offered exclusively by Epilepsy Toronto that you’re interested in, please let us know. We will do our best to accommodate your request. Epilepsy Toronto cannot guarantee entry into any program without screening. We appreciate your understanding.

Email *

Your First Name *

Your Last Name

Your preferred pronouns (select all that apply)

She/Her

He/Him

They/Them

Other:

Phone number

Please select the statements that best describe your epilepsy or seizure affiliation:

I live with epilepsy

My child has epilepsy and/or seizures.

I have functional seizures (or PNES).

I experience seizures that are not yet diagnosed.

I have a spouse, parent or sibling who lives with epilepsy and/or seizures.

I work with someone with epilepsy and/or seizures.

I have general questions about epilepsy, seizures and/or your agency.

Other:

When is your birthdate? *

If you are filling this form out on behalf of your child, what is your child's birthday?

What is your reason for reaching out to Epilepsy Toronto? (For example, recently diagnosed, looking for counselling, employment support, life skills, seizure monitor, donation, volunteer, ect.) *

What city do you live in? *

Your Postal Code *

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