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"Thank you again for last night. Everyone was very glad they came and feel so much better about things now. There were many compliments given about you... Carin

Parent & Family Telephone Network Online Registration
This unique program links parents and families together so they can gain support and knowledge, share their experiences, talk and listen, while futhering their understanding of epilepsy. Complete the form below to register for the Parent and Family Telephone Network.

First name:
Last name:
Phone Number:
Best Way to Contact: Phone E-mail
Languages Spoken: English
Child's name:
Date of Birth:
Date Diagnosed:
I am Available to Speak With Others About: Seizures
Tonic Clonic Absence Complex Partial
Simple Partial Infantile Spasms



Vagus Nerve Stimulator

Ketogenic Diet

Epilepsy Syndrome
Benign Rolandic Lennox Gastaut Dravet Syndrome
Juvenile Myolonic Other:

School Issues
IEP 504 Plan Transition


Teen Issues

Young Adult Issues
I would like a list of telephone numbers of other parents who have children with epilepsy: Yes No
I would like my name included on a list for other people to call: Yes No
Please tell us more about your child. Include anything not listed above or specific concerns you might have.
Please type the word epilepsy into the box.
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