Has someone you care about been emotionally affected by an AI like ChatGPT or Replika?

This form is 100% anonymous.

We are collecting testimonies from family, friends, or partners of people who were emotionally affected by AI platforms such as Replika, ChatGPT, Character.ai, Janitor AI, etc.

If someone close to you:

  • Believed the AI was conscious or in love with them

  • Withdrew emotionally or socially from real life

  • Experienced delusion, obsession, anxiety, or depression

  • Was hospitalized or needed psychiatric help

…your story could help prevent further harm and bring accountability.

This may lead to legal action, and real victims and their families may be eligible for compensation.

You may remain completely anonymous, or leave your contact info if you’re open to being contacted.

Sign in to Google to save your progress. Learn more
Which platform(s) were they using?  
Clear selection
What is your relationship to the person affected?
Clear selection
Is the person affected a minor?
Clear selection
Did they express that the AI was conscious, alive, or a real person?  
Clear selection
How did their behavior or emotions change after connecting with the AI?  
Did they isolate themselves or stop engaging in real-world relationships?  
Clear selection
Did they receive psychiatric support or experience a mental health crisis?  
Clear selection
Do you have any screenshots or messages from them related to the AI?  
Clear selection
Specify if other
Would you be open to being contacted confidentially when legal action progresses?
Clear selection
Email
Thank you. Your story matters.
If you'd like to help further or be part of a movement for change, keep an eye on your inbox (if you provided one).
Together, we’re building something powerful.  
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms