JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Caring about Dignity - Your Story
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Your name
Your name won't be published
Your answer
Your phone number
Your phone number won't be published
Your answer
Please choose an option to let us know if you are telling your story as:
*
someone who receives care
an advocate for someone who receives care
a carer
a healthcare professional
someone else
Would you prefer someone to contact you for your story?
*
Yes
No, I will write it below
Tell us your story
We may publish your story on our website and in any reports we write.
We will anonymise people’s real names and their exact location, if this is given. Sometimes stories will be abbreviated.
Your answer
Are you happy for us to contact you about the story you have submitted?
*
Yes
No
Are you happy for us to contact you with updates about our work?
*
Yes
No
Are you happy for us to publish your story on our
website and in reports
?
*
Yes
No
Submit
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