Chat Registration:

The following is used for conversational purposes only and is optional.
First Name

Postal code/Zip code  
Please take a moment to share some information about yourself.

All information is optional and confidential, however the information will be used to more effectively find the information and resources you are looking for. It also helps NEDA measure our outreach efforts and better determine the needs of those accessing our Helpline.

Our chat hours are Monday - Thursday 9am-9pm Eastern Time, and Friday 9am-5pm Eastern Time
Age Range of the person affected
Ethnicity of the person affected
Other - Ethnicity
Gender of the person affected
Preferred Gender Pronoun
Sexual Orientation of the person affected
I am reaching out for

Other - I am reaching out for...

To enable Google Chat or SMS (text) communications please provide the following info:
Cellular Number:


Verification: To complete the registration, solve the CAPTCHA and click "Start".
(this additional step helps prevent malicious and automated attempts to access the site)