PLEASE TELL US MORE… Has your loved one been diagnosed with Borderline Personality Disorder (BPD)? ☐Yes ☐No ☐Unsure Is your family member currently receiving treatment for BPD or other mental health issues? Yes No Unsure ☐ ☐ ☐ How old is your family member? Less than 22 years of age 22 years or older ☐ ☐ Briefly describe your situation with your loved one with BPD: What are your main objectives for participating in this program? What do you hope to take away from the program? Family Connections is a 12-week course held on Tuesday evenings from 6:00 p.m. 8:30 p.m. – Are you able to attend all 12 weeks? Yes No Unsure ☐ ☐ ☐ We will advise you 4-6 weeks before the course if space is available. If space is not available, do you want to be considered for the next course? Yes No Unsure ☐ ☐ ☐ At this time we offer Family Connections in English, we will be offering the course in French in the future. Which language would you prefer? English French (waiting list) ☐ ☐ IMPORTANT NOTE: In order to benefit from the information that is presented each week and to develop the skills, participants must agree to attend each of the 12 Tuesday evening classes except in case of emergency. In addition, participants should plan to spend about 1-2 hours per week on the practice exercises that are assigned.
PLEASE TELL US MORE… Has your loved one been diagnosed with Borderline Personality Disorder (BPD)? ☐Yes ☐No ☐Unsure Is your family member currently receiving treatment for BPD or other mental health issues? ☐ Yes ☐ No ☐ Unsure How old is your family member? ☐ Less than 22 years of age ☐ 22 years or older Briefly describe your situation with your loved one with BPD: What are your main objectives for participating in this program? What do you hope to take away from the program? Family Connections is a 12-week course held on Tuesday evenings from 6:00 p.m. – 8:30 p.m. Are you able to attend all 12 weeks? ☐ Yes ☐ No ☐ Unsure We will advise you 4-6 weeks before the course if space is available. If space is not available, do you want to be considered for the next course? ☐ Yes ☐ No ☐ Unsure At this time we offer Family Connections in English, we will be offering the course in French in the future. Which language would you prefer? ☐ English ☐ French (waiting list) IMPORTANT NOTE: In order to benefit from the information that is presented each week and to develop the skills, participants must agree to attend each of the 12 Tuesday evening classes except in case of emergency. In addition, participants should plan to spend about 1-2 hours per week on the practice exercises that are assigned.
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