When

Wednesday, April 26, 2023 at 11:00 AM EDT
-to-
Wednesday, June 21, 2023 at 12:00 PM EDT
Add to Calendar

Where

Online via ZOOM

Contact

Vijaya Kantipuly
Ontario Brain Injury Association
1-800-263-5404 ext 249
vkantipuly@obia.on.ca

Online Connection & Inclusion Support Group - Wednesday April 26 - June 21, 2023, 11 am - 12 noon

The Online Connection & Inclusion Support Group will provide free support & education to individuals with brain injury. The group runs for 60 minutes per week for 8 weeks. Due to the extensive waitlist, no more than two absences will be allowed during the 8-week sessions, please. This group is for NEW PARTICIPANTS ONLY! (Note: no group on June 7)

* Required information

Personal Information

* First Name:
* Last Name:
* Email Address:
* Confirm Email Address:
* Phone:
* Address 1:
* Address 2:
* City:
* Province:
* Postal Code:

Consent for Release of Information

I authorize the ONTARIO BRAIN INJURY ASSOCIATION (including the Executive Director, Social Worker/Clinician and Care Team Members) to disclose personal information in a secure and confidential way to enable providing appropriate support/services to my requirements. This applies to information in all forms: paper charts, administrative forms, and electronically based. I understand the purpose of sharing this information to receive care/services and may share with other service providers (where required). I also understand I may revoke this consent at any time. Note: if you have a concern about this consent, please contact our office at www.obia.ca or call: 1-800-263-5404.
*
I have read the Consent for Release of Information above and:
- I agree with the terms
- I do NOT agree with the terms

Personal HIstory

* What physical symptoms are you experiencing following your brain injury?
characters remaining
* Are you experiencing any symptoms of anxiety, depression, mood changes, difficulty coping with stress, PTSD, etc. following your brain injury?
characters remaining

I do not wish to receive any further correspondence from Ontario Brain Injury Association

By checking this box, you're consenting to receive marketing emails from:
Ontario Brain Injury Association, PO Box 2338, St. Catharines, ON L2R 7R9, Canada
https://obia.ca/
You can revoke your consent to receive emails at any time by using the SafeUnsubscribe^TM link, found at the bottom of every email. Our Privacy Policy.
Emails are serviced by Constant Contact.

Mobile View

Desktop View