Vision Loss Social Emotional Support Groups

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Vision Loss Social Emotional Support Groups

We tried to make this form as accessible as possible. If you are having trouble filling it out feel free to email us at joy@doublevisionblog.com

First Name *

Last Name *

Email *

Would you like to receive email updates from Doublevisonblog

Yes

Age

Gender

Male

Female

Prefer not to say

Other:

Clear selection

What type of group are you interested in?

Dealing with grief shame and other common emotions related to vision loss

Navigating vision loss in the workplace

Parent or family member of someone with vision loss

Do you prefer to be in a group with others in a similar age range or mixed ages?

Similar age group

Mixed ages

No preference

Clear selection

Do you prefer to be with same-gender or a mixed group?

Same-gender

Mixed-gender

No preference

Clear selection

Beginning the week of September 12th and ending the week of October 17th, 2022, which days and times work for your schedule?
*

Tuesdays 5pm-6pm PST

Thursdays 5pm-6pm PST

Saturdays 10am-11am PST

Other:

Anything else you'd like us to know?

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