The second Monday of every month, 4 PM CST.  Directions to join and link will be emailed to you shortly before the meeting date.
Sign in to Google to save your progress. Learn more
Your First and Last Name
Person with ALS First and Last Name
Your Email
Your Phone
Person with ALS's Care Service Coordinator
Regarding Confidentiality:  Anything said between any two or more group members at any time is part of the group and is confidential​. ​ I understand that everything said in this group is confidential and not to be shared with anyone outside of the group, except as may be otherwise required by law.  I agree to keep confidential the names of other members of the group and what is said in the group. As a member of this group, I agree to not disclose to anyone outside the group any information that may identify another group member. This includes, but is not limited to, names, physical descriptions, biological information, and specifics to the content of interactions with other group members.   I agree to indemnify and hold ALS Association St.Louis Regional Chapter harmless for any loss or damages, including costs and attorney’s fees, incurred by ALS Association St.Louis Regional Chapter as a result of my breach of another’s confidentiality.  Further information regarding these situations and my privacy rights will be provided in the Notice of Privacy Practices for Protected Health Information  I also understand that anything said in group is confidential, ​except ​ for the following limitations:  ●Child abuse or neglect ● Vulnerable adult abuse or neglect ●Threats to harm oneself ● Threats regarding harm to another person  ● A court subpoena
Clear selection
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy