Survivor Story Interest Form Name(Required) First Last Email(Required) Phone(Required)What was your age at the time of your stroke?(Required)What type of stroke did you have?(Required)IschaemicHaemorrhagicTIASpinal cordCVSTUnknownOtherIf you selected 'other' type here:Do you need support to share your story?(Required)No, I am happy to write it myselfYes, I would like a phone or video callWould you be open to your story being shared with the press or used in awareness work?(Required)Yes, I would like to know moreNo, not at this timeIf you need a supported call, please note there may be a wait.Would you like to join our mailing list and receive information and updates?(Required) Yes please No thank you Δ
