WeCanOnline
An 'online community of peers' for people with a lived experience of Borderline Personality Disorder
* Required
What is your name? (first name please, surname optional)
*
Your answer
What suburb or town do you live in?
*
Your answer
What state or territory are you from?
*
Your answer
Postcode:
*
Your answer
Do you currently or have received services from the public mental health sector?
*
Yes
No
Prefer not to answer
Do you currently or have received services from the private psychiatric hospital sector?
*
Yes
No
Prefer not to answer
Do you currently or have received services from a psychiatrist, psychologist or other professional in their consulting rooms?
*
Yes
No
Prefer not to answer
Email:
*
Your answer
Please re-enter email:
*
Your answer
Disclaimer
Please note this is not a crisis service and this form is not constantly monitored. If you are in need of crisis assistance, please contact Lifeline on 13 11 14 or SA Mental Health Triage 13 14 65. Please be aware that if a coordinator assesses that an email requires a crisis response it will be referred on to Lifeline.
Privacy
The details you provide will be held according to the Australian BPD Foundation's privacy statement here: and will be only used to contact you regarding activities that may be relevant for you. You may unsubscribe at any time by sending an email to
WeCanOnline@bpdfoundation.org.au
.
Our contact details:
Australian BPD Foundation Limited
PO Box 942
BAYSWATER VIC 3153
+61 4 58 469 274
WeCanOnline@bpdfoundation.org.au
http://bpdfoundation.org.au
ABN: 83 163 173 439
Submit
Page 1 of 1
Never submit passwords through Google Forms.
Forms
This content is neither created nor endorsed by Google.
Terms of Service