Family Education and Support Group


Is it okay to leave a phone message?
 Yes    No

How do you identify your cultural background?
This information will increase our awareness of specific cultural concerns and practices, and help us identify who we are reaching with this program.

 African Nova Scotian
 New immigrant

The person with a mental health/addiction problem or illness is your:

Age of the person you are supporting
 Under 12

How did you hear about this program?
 Community Health Team
 Family Doctor
 Mental Health Professional
 Family Member
 Community Organization

Do you consent to being contacted within the next 12 months for a follow up evaluation?
 Yes    No

What is your preferred language?
 English    French

If you dont know your zone please refer to the link below.
Please Click Here

What is the mental health/addiction problem or illness? Please check all that apply:
 Schizo-affective disorder  
 Drug/alcohol addiction/gambling or gaming  
 Bipolar disorder  
 Anxiety Disorder  
 Obsessive Compulsive Disorder  
 Personality disorder