Request for FREE What is Aphasia? Booklets

IMPORTANT: Please read the instructions below before filling out the form

ONTARIO ONLY – If you are a Health Care Professional working in Ontario, you are eligible to order up to a maximum of 25 FREE hard copies of the “What is Aphasia?” resource. Please note: The Aphasia Institute absorbs a significant cost to continue to provide the free booklets at this time. Please only order the amount you need.

To proceed: Please complete the form below. If you require more than 25 booklets, please contact cpereira@aphasia.ca. These will be discussed on a case-by-case basis.

OUT OF PROVINCE – If you are not in Ontario or would like a hard-copy of the “What is Aphasia?” resource, please click here. Do not complete this form.

Order Hard Copies (English and French)

Name*

Title/Position*

Profession*

Where do you fit on the continuum of care?*

Mailing Address*

This resource is Free for Ontario residents ONLY - Please visit our store: *Revised 3rd Edition* What Is Aphasia?

Ontario Health Region where you work*

To check your Ontario Health Region:
EN: https://www.ontariohealth.ca/about-us/our-programs/ontario-health-regions
FR: https://www.ontariohealth.ca/fr/a-propos-de-nous/nos-programmes/regions-de-sante-ontario

Phone Number*

Email*

Number of copies needed in English*

Number of copies needed in French

Please comment*:

Tell us how you are using these booklets.
What do you think is the impact of the booklets on people living with aphasia?