Check-In Chat

Check-In Chat

A Chance to Connect During a Disconnected Time
We are witnessing mandated social isolation and social distancing on an epic scale. As part of BIAMD's interest in serving Maryland's Brain Injury Community, we are starting what we call "Check-In Chats".

We would like to "check in" with anyone looking to share their experiences and challenges with either an individual or in a social group setting.

There are many ways open to us, and, if you are interested, we would like to hear from you about your needs and how we can help you feel more connected.

Once we hear from you, we can move forward in setting up our chats.

We look forward to chatting with you soon.
Full Name*

First NameLast Name
My pronouns are:

He/Him/HisShe/Her/HersThey/Them/TheirsZe/Hir/Zir/Hirs/ZirsOther
I am:*

Individual with a Brain InjuryFamily MemberCaregiverHealthcare ProfessionalOther
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
E-mail
I prefer to be contacted by*

PhoneEmail
I am looking for (select all that apply)

Group Social ConversationOne on One Social ConversationInformation and ResourcesOther
Any other information you feel we need to know before we follow up:
If you have any questions, please contact us at info@biamd.org. Please use the Subject Header: Check-In Chat.

By submitting this form, you are agreeing that BIAMD may use the information in this form to contact you for purposes of setting up a time and place to chat.
Should be Empty: