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Please e-mail us at vgm.info@nzord.org.nz if you have difficulty with this form.
Family name
Mother's name
Father's name
Name of child with VOGM
Sex
Birthday
Age
Brief description of treatment and progress to date
Any other medical information
Names and ages of any siblings
Name of key contact for your family (one person)
Contact's relationship to family member with VOGM
Contact address
Country
Contact phone numbers
Contact e-mail address
Would you like to receive our support group e-newsletter?
E-mail address newsletter can be sent to
Are you happy for your details to be shared with other members of the support group for communication and support? Some families find it helpful to talk with others with similar experiences. Due to distance, we have found e-mail to be the best way of communicating and giving support.
Are you interested in writing your child's/family's story for our family stories page on the website?
Any other feedback, questions, concerns or comments
