Skip to content
Monthly Meet Up for Young Adults with Epilepsy (18-24 years)
Registration Form for Monthly Meet Up (MMU)
If you’re aged 18-24 and living with epilepsy, why not join us for our Monthly Meet-Up (MMU)?
*
1.
What is your name (first name and surname).
(Required.)
*
2.
Please enter your contact number
(Required.)
*
3.
Please enter your email address
(Required.)
*
4.
This group is for young adults with epilepsy, aged 18-24 years.
What age are you?
(Required.)
*
5.
What county do you live in?
(Required.)
*
6.
Have you previously linked in with your local Community Resource Officer?
(Required.)
Yes
No
*
7.
What age were you when you were diagnosed with epilepsy?
(Required.)
*
8.
How would you rate your knowledge of your diagnosis/epilepsy?
0 = I have no knowledge
10 = I have all the knowledge I need
(Required.)
0
10
Clear
*
9.
How easy is it for you to meet other young people living with epilepsy?
0 = I have not met any other young people with epilepsy
10 = I find it very easy to meet other young people with epilepsy
(Required.)
0
10
Clear
*
10.
Why are you interested in participating in this group?
(Required.)
To meet/connect with other young people with epilepsy
To learn more and better understand my condition
To improve my self-management of my epilepsy
To have a safe / non-judgemental space to share experiences
Other (please specify)
*
11.
How does your epilepsy impact your day-to-day life
0 = Does not impact my life in any way
10 = Impacts my life on a day-to-day basis
(Required.)
0
10
Clear
*
12.
Do you feel that you have missed out on activities/events due to your epilepsy?
(Required.)
Yes
No
Do you want to add anything?
*
13.
What are the main issues that concern you as a young person living with epilepsy? Or - are there any topics you would like to see addressed during the sessions (e.g. mental health/wellbeing, memory/study/exams etc.)
(Required.)
*
14.
How comfortable are you in telling people outside your family/friend group about your Epilepsy?
0 = Extremely Uncomfortable
10 = Extremely Comfortable
(Required.)
0
10
Clear
*
15.
What are the three things you are hoping to get from participating in this group?
(Required.)
1.
2.
3.
16.
Thank you for taking the time to answer these questions. It will allow us to plan, prepare and evaluate our work.
Have you any questions for us?
