The following survey is designed for polio survivors, living in Australia, who were born from 1975 onwards.
    Polio Australia is currently developing specific resources and supports to assist younger survivors to manage their condition into the future. Most of the current information on the Late Effects of Polio (LEoP) has been developed with older Australian or European polio survivors in mind, which means that younger polio survivors are not connecting with either Polio Australia or the state Polio Networks.

    Your name (optional)

    Your email (optional)

    Your phone number (optional)

    Your birth year (required)

    In which year did you contract polio? (required)

    In which country did you contract polio?

    In which suburb or area are you currently living?

    I am currently:
    StudyingWorking full-timeWorking part-timeWorking casuallyWorking temporarilyWorking contractReceiving Disability Support PensionNot working

    Do you know about Polio Australia's work?

    Would you like to connect with polio survivors of similar age to you?

    How would you like to connect with polio survivors similar age to you?
    Facebook groupFacebook pageOnline forumIn-personVia telephoneOther:

    The Late Effects of Polio (LEoP) can become apparent from 15 years following the initial infection and include a range of new symptoms resulting from bio-mechanical and/or neurological decline; these symptoms can have potentially debilitating health effects. Polio Australia's vision is that all polio survivors in Australia have access to appropriate health care and the support required to maintain independence and make informed life choices.

    What information and/or support would you like from Polio Australia?

    What resources and/or health professionals do you use? (Select all that apply)
    NDISSpeech PathologistOrthotistDietitianPsychologist/Social WorkerExercise PhysiologistPhysiotherapistOccupational TherapistPodiatristRespiratory SpecialistMassage TherapistDisability Support (Please state which)

    Do you agree to be contacted by Polio Australia to discuss your experience further?

    Would you like to receive Polio Australia's newsletter and other resources?