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PSSD Interview Request Form
Hi, I'm Emi Nietfeld!
Thank you for helping me report about PSSD. This is a preliminary set of questions as I dig into reporting.
Please feel free to share this with anyone who might want to participate.
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Email *
Your name / how you'd like me to call you - I will not share this without permission. 
Location
Age
Tell me your story. A few prompts:
- How long have you been experiencing PSSD?
- What medications did you take that you believe caused PSSD?
- What symptoms of PSSD are you experiencing? Have you tried any treatments for PSSD? 
- If so, what were the results?
Have you experienced any adjacent conditions?
Most importantly - How has PSSD impacted your life? How does it make you feel? 
I really want to capture the impact of this condition. Please don't hold back! 
Is there anything else I should know about? 
What is your preference about using your name? Would you potentially be open to using your first name or full name in a story?
The most well-read, reputable outlets (like the New York Times and Washington Post) usually require using full names for sources quoted in depth so it's useful to know who might be open to that. 
This is not a binding agreement in any way! 
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