Community Advisory Council

Contact Form

Thank you for your interest in applying for our Community Advisory Council. Please enter your information below. We will contact you in the next few weeks to schedule an interview.

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* 1. Name

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* 2. Email address

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* 3. Are you the parent of a child who has had epilepsy surgery?

Yes

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* 4. Which statement best describes you?

I am the parent of a child who has had brain surgery to stop seizures.

I am the parent of a child who has been considered for epilepsy surgery, but has not had surgery yet.

I am the parent of a child who has had a surgical evaluation, but we have been told is not a surgical candidate.

I am an adult who had brain surgery to stop seizures when I was age 17 or younger.