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Epilepsy Questionnaire
Preference?
Counselling
Self-Funded (quick start)
Self-Funding & NHS Application
NHS Application Only
Other
Other
With regret NHS England or Wales will not fund specialist counselling. They require all people with Epilepsy to be seen by the local mental health team.
You are?
Your Name
*
Post Code
Date of Birth
Email
*
Your Epilepsy?
Age?
When you had your first seizure (approx)
Classification?
Not Sure
Focal Seizure
Tonic Clonic
Partial Seizure
Clonic
Absence
Myoclonic
Tonic & Atonic
If you are human, leave this field blank.
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