Name
*
First Name
Last Name
Email
*
example@example.com
Your date of birth
*
-
Month
-
Day
Year
Date
Where do you live?
*
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you a stroke survivor or caregiver?
*
Please Select
I am a stroke survivor
I am a caregiver
When was the date of your stroke?
-
Month
-
Day
Year
Date
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About your stroke journey
Tell us your story from the beginning to now, sharing anything you feel comfortable with.
If you could give some advice to a stroke survivor in recovery now, what would it be?
Tell us about one thing that helped you stay mentally strong through your recovery.
Please list any tools or resources that have helped you in your journey.
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About your caregiving journey
Tell us your story from the beginning to now, sharing anything you feel comfortable with.
If you could give some advice to a caregiver now, what would it be?
Tell us about one thing that helped you stay mentally strong as a caregiver.
Please list any tools or resources that have helped you in your journey.
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Uploads
Please upload any images or videos you'd like us to share with your story.
Browse Files
Drag and drop files here
Choose a file
The Stroke Foundation reserves the right to choose to share certain videos/images to ensure the protection of our community.
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Consent to contact and story publication.
Required consents
*
I consent to The Stroke Foundation to contact me via email.
I consent to having my story published as a blog post on it's website and the Foundation's social media.
I understand The Stroke Foundation reserves the right to decide when and how stories are published.
Optional consents
I would like for my story to be shared anonymously.
I would like to sign up for The Stroke Foundation's monthly newsletter
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