LWIH Attendee Information
It is a requirement that all individuals attending LWIH support groups complete this document to ensure all attendees have agreed to the guidelines
https://bit.ly/3oXmlhu
(you will only need to do this once).
This form is for Hypersomnolence Australia's reference only.
* Required
Email address
*
Your email
Full Name
*
Your answer
Where do you live?
*
Choose
NSW
VIC
WA
ACT
NT
SA
TAS
QLD
NZ
How old are you?
Your answer
Do you have a diagnosis of Idiopathic Hypersomnia?
*
In order to attend a LWIH support group you are required to have a diagnosis of IH. Any exceptions will be at the discretion of the facilitators.
Yes
No
I am a parent of a minor (under 18yrs) child diagnosed with idiopathic hypersomnia
I am a parent of an adult (over 18yrs) child diagnosed with idiopathic hypersomnia
Do you foresee a challenge with showing your video during the LWIH support meetings?
*
It is a requirement of LWIH support meetings that your video is displayed at all times. Please contact facilitators if this is a concern.
Yes
No
Maybe
Other:
Have you read the 'information and guidelines for attendees' document and do you agree to follow these guidelines?
*
Yes
No
Other:
Are you interested in receiving information and material regarding our support group meetings?
*
Yes
No
Other:
How did you hear about LWIH support groups?
*
Hypersomnolence Australia or Idiopathic Hypersomnia Awareness Week Facebook/Twitter/Instagram page
Hypersomnolence Australia Website
Email from Hypersomnolence Australia
Post in one of the Idiopathic Hypersomnia Facebook Groups
Other source on social media
Friends and Family
Other:
Required
Do you have any concerns or questions about attending LWIH support groups?
Your answer
Send me a copy of my responses.
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