Informal Consumer Carer Group for BPD

I would like to join the Network's BPD Informal Consumer & Carer Group

You may choose only to be identified by your email address. There is no requirement to provide ANY OTHER PERSONALLY IDENTIFYING INFORMATION.

In joining this informal group, you agree to be contacted by email for exchange of information which will assist us in advocating for better services.

To join, please answer the following questions.
Those questions marked with an asterisk require an answer all others are optional.

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Informal Consumer Carer Group for BPD

I would like to join the Network's BPD Informal Consumer & Carer Group

1. Name: (Optional)

2. Address: (Optional)

*
3. Email address:

*
4. In which State / Territory do you live?

*
5. Where are you located?

*
6. Gender:

*
7. Are you a Consumer or Carer?
Please select only one option.

8. How long have you had the diagnosis of BPD or cared for someone with the diagnosis of BPD?

Address: (Optional) Number and Street
Suburb
Postcode

Informal Consumer Carer Group for BPD

I would like to join the Network's BPD Informal Consumer & Carer Group

1. Name: (Optional)

2. Address: (Optional)

*3. Email address:

*4. In which State / Territory do you live?

*5. Where are you located?

*6. Gender:

*7. Are you a Consumer or Carer? Please select only one option.

8. How long have you had the diagnosis of BPD or cared for someone with the diagnosis of BPD?

*
3. Email address:

*
4. In which State / Territory do you live?

*
5. Where are you located?

*
6. Gender:

*
7. Are you a Consumer or Carer?
Please select only one option.