JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Share your healing story.
The more stories we share the more people we can help.
You are the hero!
Please fill out the form below and we will contact you to schedule a podcast iterview.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Name
Your answer
Phone Number
*
Your answer
What injury, illness, disease or challenge did you heal from? (you may list more then one but please include what you would like to talk about in your healing story)
Your answer
On a scale of 1-10 how sick or in pain did you feel when you were at your worst?
*
I felt like I was dying.
1
2
3
4
5
6
7
8
9
10
I felt healthier than ever!
On the same scale how do you feel now?
*
I feel like I am dying.
1
2
3
4
5
6
7
8
9
10
I feel healthier than ever!
*
I would like to be interviewed on the Humans Heal podcast
I would like to submit my healing story in writing
I would like to submit my healing story in audio or video format
I know someone else who might want to share their healing story
I want my story to be share anonymously
Required
Next
Page 1 of 2
Clear form
Never submit passwords through Google Forms.
Forms
This content is neither created nor endorsed by Google.
Report Abuse
Terms of Service
Privacy Policy