The Cavernoma Society Secret Society membership form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

We at The Cavernoma Society are delighted to share this secret community that we have been building for you on the Mighty Networks platform. This will be a safe space to share, ask questions, gain insights, watch videos and find information, and feel less alone. In order to make this a safe, protected space we need to verify each user. In order for us to verify you please sign up using this form and then request to join the group. Once we've verified you we will add you to the group.

Many thanks,

The Cavernoma Society

Email *

Full Name *

Age *

Are you a.... *

Patient

Carer

Family Member

Parent

Please tell us a bit about your cavernoma story. This can be anything from: when you were diagnosed, how you found out about your cavernoma, do you have the genetic condition or the sporadic form, have you had surgery, what you symptoms are, what you've learned, and how you manage on a daily basis? *

How old were you/your family member when you/they were diagnosed? *

What would you like to get from this community? Do you feel you know enough about cavernoma? What tools and resources would help you? *

Quiz Questions

Which of the following resources would you use if they were available via the platform? *

Gentle exercise/neuro-rehab movement videos?

Blogs on living with a cavernoma?

Meditation videos and audio?

Helpful tips and hints?

Zoom/virtual counselling support groups (4-8 people)

Information on benefits and disability?

Art therapy classes?

Information about cavernoma?

one-to-one counselling?

Nutrition and cooking classes?

Other:

Required

How much do you feel you know about cavernoma? *

A lot

Nowhere near enough

Nothing

Not enough, but I'm getting by

Enough

Other:

Required

Is there anything you'd like to add?

Disclaimer

All of your answers are conditional and will not be shared with anyone outside of the charity. This information will be stored under Data Protection Laws and used to verify you and make sure that this group will be suitable to your needs. By completing this information and joining this group, you agree to become a member of The Cavernoma Society (a Registered Charity in England and Wales: 1184406). This is completely free and requires nothing on your part.

Would you like to sign up to our newsletter? We promise we won't spam you! *

Yes

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of The Cavernoma Society.

Does this form look suspicious? Report

Forms