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Name:
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I am between :
18 -29
30 - 45
46 - 59
60 and Over
Gender:
Male
Female
Date of Birth:
Type of Disability:
I am not telling you
I am not disabled
I am a carer
Amputee
Arthritis
Arthrogryposis
Aspergers Syndrome
Asthma
Bi Polar Disorder
Blind / Sight Impaired
Brain Injured
Burn Victim
Cancer
Cerebral Palsy
Crohns Disease
Cystic Fibrosis
Deaf / Hearing Impaired
Depression / Anxiety
Diabetes
Dwarfism
Dyslexia
Epilepsy
Fibromyalgia
Hemiplegic
Learning Disabled
Lymes Disease
M.E
Multiple Sclerosis
Muscular Dystrophy
Myopia
Neurological Disorder
Obesity
Paraplegic / Quadriplegic
Parkinsons Disease
Polio
Schizophrenia
Spina Bifida
Stroke Survivor
Wheelchair User
Other
I am here for:
meeting new friends
have fun
to meet someone with the same disability
to talk to carers
to find a partner
don`t know
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