You and your details Please tell us which country you live in * We need this information to be able to help you. Your Name * Your Email * Your current email address where we can send a reply to. Can we send you email updates on the work of Epilepsy Action and its trading company? * YesNo We often receive helpline questions from email addresses that don't work. If your email address doesn't work, we won't be able to send you our response to your question. If you haven't heard back from us it's probably because we have no way of contacting you. Please try again, ensuring that you've typed in your email address correctly and that there are no problems with your email account. Phone number Postal Address Mobile phone number Can we send you text message updates on the work of Epilepsy Action and its trading company? * YesNo Contacting you again Contacting you again No mail No telephone We would really like to keep you up to date with the work of Epilepsy Action and others ways you can support it, including through our trading company. If you prefer not to be contacted in any of these ways, please tick the boxes: We will not share your details with anyone else. Your question Please select the general area of your question - None -Information about and comments on Epilepsy ActionEpilepsy and educationEpilepsy and employmentEpilepsy, leisure and lifestyleEpilepsy and insuranceEpilepsy and drivingEpilepsy diagnosis, care and treatmentEpilepsy and sexual/reproductive mattersGeneral facts about epilepsySudden Unexpected Death in Epilepsy (SUDEP) Your Question * What's your connection with epilepsy? - None -Person with epilepsyFamily memberCare StaffConsultant/hospital doctorGP/local doctorNurseEducation professionalEmployerGeneral interest Please tell us a little about the person with epilepsy. This will help us give you a more detailed reply: Gender - None -MaleFemaleThe question's not about a specific person How old is the person with epilepsy? Can we keep brief notes about this email on our system? * YesNo Epilepsy information pack Would you like us to send you an epilepsy information pack? Yes please (UK residents only) Epilepsy Action privacy policy
