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Neola Hybrid NAMI Family Support Group Registration
Meeting Information:
First Tuesday of each month
6:30 PM - 8:00 PM
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Email
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Your email
First Name
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Your answer
Last Name
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Your answer
Street Address
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City
Your answer
State
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Zip
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Phone Number
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Your answer
Your emergency contact
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Your answer
Emergency Contact Phone Number
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Your answer
Have you attended a support group before?
No
Yes
Yes, I have attended a NAMI Family Support group in the past
Other:
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All NAMI Family support group members must be 18 years or older
*
I am 18 years old
I am under the age of 18 but would like a referral
The Zoom platform we will be using will be a private meeting, however it is not HIPPA approved and NAMI SW Iowa cannot guarantee confidentiality of information you share during the support group meetings held virtually.
*
I understand and would still like to participate
I no longer want to participate but would like information for HIPPA approved, individual counseling services from a professional provider
I would like more information on this issue before participating
Anything else you'd like the organizer of this support group to know about you? If you have specific questions you can also enter them here.
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