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Registration

If you would like to register with the TBPI Group please fill in this form and click on the SUBMIT button. The form is in three parts; the first part is for everyone to fill in. The second part is only for people with a BPI , and the last part is for other visitors, for example, parents of someone with a BPI.

Your Name (required)

Your Email (required)

Postcode (for demographic purposes)

Date of Birth

Your Gender
MaleFemale

Do you have a Traumatic Brachial Plexus Injury?
YesNo

Please click on the button that best describes your injury
Trauma BPIBP Related e.g TOSUndiagnosed

Date your injury occurred or was first noticed or diagnosed:

Would you be happy to take part in any on-line surveys on this site about BPI?
YesNo

Are you one of the following; (Please click one of the statements in the dropdown list below)
The partner of someone with a TBPIThe parent of someone with a TBPIOther relativeFriend of someone with a TBPIPhysiotherapistOccupational therapistOther therapistMedical practitionerOther

Date of injury to your partner/relative/child/friend

Would you be happy to be put in touch with other TBPI's in your area?
YesNo

Please tick this box to confirm you consent to our Data Protection Policy
I Agree

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