JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Share Your Flood Health Experience with Planet Detroit Reporter
Planet Detroit reporter Ethan Bakuli is investigating the long-term health effects of repeated flooding in Metro Detroit. Share your story to contribute to this important reporting.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Full Name
Your answer
Email Address
Your answer
Phone Number
Your answer
Please share your experience with long-term physical or mental health effects from repeated flooding in Metro Detroit. How has it impacted your life?
Your answer
Willingness to be Contacted
I am willing to be contacted by Planet Detroit’s Climate Solutions and Service Journalism Reporting reporter, Ethan Bakuli, to discuss my experience further.
Submit
Clear form
Never submit passwords through Google Forms.
Forms
This form was created inside of Planet Detroit.
Report Abuse
Terms of Service
Privacy Policy
Help and feedback
Contact form owner
Help Forms improve
Report