NAMI BASICS (if your loved one is 17 years or younger)
Register for the FREE, six-session program designed for parents and other family caregivers of children and adolescents (17 years or younger) with emotional and behavioral difficulties. *If your loved one is an adult, please go to the Family to Family Education Program and complete the form.
Email Address *
Your answer
Last Name *
Your answer
First Name *
Your answer
Address *
Your answer
City *
Your answer
Zip *
Your answer
Phone Number *
Your answer
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 loved one with illness *
Your answer
Relationship to you *
Your answer
Age *
Your answer
Gender
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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