APNI FEMALE VOLUNTEER FORM

If you wish to help as a volunteer at APNI please fill in the details below and we’ll get back to you as soon as we can. Please note that this form is for women only. Our volunteer system requires sensitivity to how we can use volunteers which is why the APNI has a separate volunteer forms. If you are a male who wishes to volunteer please click here .

Furthermore, as advised by our medical committee, kindly note that we ask all volunteers be completely well and recovered from postnatal depression for a minimum period of six months.

Name

Phone Number

Postal Address

1. How soon after the birth of your child did you become depressed?

2. Date of birth of your child/children?

3. How long did your postnatal illness last?

4. Did you take any medication for postnatal illness, if so which ones?

5. Are you still taking any medication? If not, when did you stop?

6. Did you receive any counselling or any other therapy, if so which ones?

7. Do you have strong feelings for or against drugs treatment?

8. What were the main symptoms of your illness? (please tick all appropriate boxes)

9. Have you experienced any other persistent symptoms?

10. Did you suffer with ante-natal depression before postnatal depression?

Yes No

11. How long have you been well since your episode of post natal depression?

12. Did you have any previous mental ill health before post natal depression?

Yes No

If yes, please give details including medication and treatments:

13. Would your partner be prepared to talk with partner of a currently depressed mother?

Yes No

14. Would you be willing to do postal support?

Yes No

15. Are you willing to talk to journalists about your experience of post natal depression?

Yes No

16. Are you able to do talks for professional groups about your experience of PND? Yes

Yes No

17. Do you speak any languages? If so please state which:

18. Please write any comments that you feel may be relevant or helpful:

APNI FEMALE VOLUNTEER FORM

CONTACT FORM