Share your experience....
Please share your experience taking or withdrawing from domperidone as a lactation aid.  This form is intended for people who have experienced negative side effects or withdrawal symptoms.  In this form, you have the opportunity to write your story, and a more detailed questionnaire follows below.  Please complete as much, or as little, of the form as feels relevant to you.

The purpose of collecting this information is to compile an informal report to be shared online (https://sites.google.com/view/domperidone-syndrome), with lactation support workers, and with health Canada.  The narratives will be shared on this website (in the 'our stories' section).   Your story is important regardless of your geographic location, if you are in Canada you will have the option of including your contact information for the report to health Canada.  The report will be compiled in September of 2022. You can also sign the open letter here:  https://forms.gle/qmDBQU5pDKNJbvBx7

This website has been created as a voluntary effort to raise awareness of the potential harmful effects of domperidone and the need for further research.  This is an effort I began following my own experience.  There is not institutional support for this effort.  If you require support or further information, please contact a medical professional.  You may also find support through facebook communities such as "support for mothers on domperidone".  
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Optional: Would you like to receive information about the progress of the report?  If so, please provide your email address.  
Share your story....
Thank you for sharing!  Your story will be published on the 'our stories' page of this website (https://sites.google.com/view/domperidone-syndrome) and included in the report.  Please complete the information questionnaire by clicking 'next' below.  
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