Self Registration Patient - communication

Registration Form

Step 1 of 7

First Name

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Last Name

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Age Range

65 or under 65

65+

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Why do you have communication issues?

a stroke

a brain injury

other

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Occupation

Not working right now

Retired

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Preferred text-to-speech rate

Everyday

This is a test sentence spoken at everyday speed.

Slow

This is a test sentence spoken slowly.

Very Slow

This is a test sentence spoken very slowly.

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Preferred Notification Method

Send me
emails

Send me text
messages

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Phone Number

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Email Address

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@

.

.com

.com.au

Password

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