UPLIFT 2024

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

UPLIFT 2024

“Using Practice and Learning to Increase Favourable Thoughts” (UPLIFT) is a mindfulness-based cognitive behavioural therapy program offered over 8 weeks (virtually) that improves depression and overall psychological quality of life. If you are an adult with epilepsy, or a parent of someone with epilepsy, and would like to be part of this FREE program, please complete the form below.

*Note: You must be 18 years of age or older to participate in UPLIFT

FIRST NAME *

LAST NAME *

EMAIL ADDRESS *

PHONE NUMBER *

FULL MAILING ADDRESS *

DATE OF BIRTH *

I AM: *

A person living with epilepsy

A parent or caregiver of a child living with epilepsy

Other:

Which of the following do you struggle with?

Depression

Anxiety

Both anxiety and depression

General stress

Unsure

Please indicate your preferred type of session

General adult living with epilepsy group

Parent or Caregiver of a child with epilepsy group

Employment focused group

Other:

Clear selection

UPLIFT is offered virtually. Please check this box to confirm that you have access to a reliable internet connection. *

Yes I have access to reliable internet connection

No I do not have access to internet connection

Required

Please let us know if you have any questions or have additional information you would like to provide.

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Epilepsy Toronto. Report Abuse

Forms