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Afghanistan
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Are you an Oley member?
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Sex
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Marital Status
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Single
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Race
Your role in the Nutrition Support Community (check all that apply)
A patient using a feeding tube (EN)
A patient using IV nutrition (PN/TPN)
A caregiver for someone using nutrition support
A former patient or caregiver
Both and EN and PN
How long have you or your loved one used nutrition support?
Less than 1 year
1–5 years
6–10 years
10+ years
20+ years
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Would you be interested in sharing your story with Oley?
Yes
Maybe / depends on the project
I’d like more information first
What type of participation would you be open to? (Check all that apply)
Recorded video interview
Short selfie-style video (recorded at home)
Written responses used in a video
Voice-only (no face shown)
Photos with captions
I’m not sure yet
Other
Are there any topics you would not want to discuss?
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Which topics would you feel comfortable sharing about? (Check all that apply)
Daily life with nutrition support
Identity and life beyond medical care
Being a caregiver
Mental and emotional wellbeing
Relationships and social life
Navigating school, work, or parenting
Advocacy or awareness
Long-term living with nutrition support
Other
Which best describes how you prefer your story shared? (Check all that apply)
Educational and informative
Personal and reflective
Short and simple
Creative or expressive
I'm open to different styles
How comfortable are you being identified publicly?
Comfortable using my full name
Prefer first name only
Prefer anonymity
Not sure yet
When are you generally available for recording? (Check all that apply)
Weekdays
Evenings
Weekends
Flexible
Do you have access to a phone, tablet, or computer with camera?
Yes
No
Not sure
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If there’s one thing you wish people understood about life with nutrition support, what would it be?
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I understand this form is for interest only, and that Oley may contact me about future ways to share my story.
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