NAMI SGV Family to Family Class
Registration for our FREE 12-session Family to Family educational program.
* Required
Email
*
Your answer
Last Name
*
Your answer
First Name
*
Your answer
Address
*
Your answer
City
*
Your answer
Zip Code
*
Your answer
Phone Number
*
Your answer
Preferred Language
English
Spanish
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 your family member living with a mental illness
Your answer
Relationship to you
*
Your answer
Age
*
Your answer
Gender
Female
Male
Prefer not to say
Age of illness onset
*
Your answer
Diagnosis, if diagnosed
*
Your answer
Medications used
*
Your answer
Living arrangements
*
Your answer
Other information
Your answer
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