NAMI Solano County Peer to Peer Registration

Welcome! Thank you for your interest in the NAMI Peer to Peer program. Please register by completing the form below.

Today's Date
Date Format: MM slash DD slash YYYY
Your Email Address*
First Name*
Last Name*
Phone*
Address*
Street Address City State Zip
Your ill family member’s relationship to you (brother, daughter, spouse/partner, father, etc.)*
Diagnosis (if known)
Family member’s age when first diagnosed or symptoms began
Family member’s current age
Does the family member currently live with you?
- Yes
- No
Do you have experience using Zoom (a platform for online meetings)?
- Yes
- No
How did you hear about the Peer to Peer program?
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