Epilepsy Contact Database


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The purpose of the form below is common communication. Sherry and I find that at times it's easier to e-mail our grief and concerns, rather than express them openly. Rarely do we find anyone who can truly relate. Either the child is of a different age, is taking a different medication, or does not even have epilepsy. Who is there to sympathize with?

The form below will enter you into a database of common characteristics. Once entered, you will be e-mailed the database's private Web site address that will allow you access to those participating in all three databases. This Web site address is made available only to the database participants. Contact these people, comfort them and be comforted. Having a child with epilepsy can be a lonely life.

When done, click on "Submit." This information will be shared only with those people that participate in this program.

Your first name: Last name:

Child's first name: Child's age:

Seizure type: Seizure frequency: (e.g. 3/month)

Medication(s) being taken:

Child's state of health:

E-mail address:

To ensure accuracy, please type your email address again. It is required for entry into the database.

E-mail address: State or country (optional): (e.g. Canada)

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