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Perinatal Psychosis Storytelling Interest Form
Contact Information
Name
First Name
Last Name
Email
Verify Email
State you live in
*
Gender
*
Race
*
What is your preferred language? Are you comfortable speaking, reading, or writing any other languages?
*
What is your experience with perinatal psychosis? (Check all that apply to you)
I am an individual with lived experience of having pre-partum psychosis (during pregnancy )
I am an individual with lived experience of having postpartum psychosis after experiencing pregnancy or infant loss
I am an individual with lived experience of postpartum psychosis after having a baby
I am a family member of someone who has experienced pre-partum psychosis (during pregnancy)
I am a family member of someone who has experienced postpartum psychosis after pregnancy or infant loss
I am a family member of someone who has experiences postpartum psychosis after having a baby
I am a medical professional in the field of perinatal mental health and have been affected by perinatal psychosis
I do legal advocacy work for perinatal mental health and have been affected by perinatal psychosis
Other:
If you checked other, please explain:
Are you interested in being considered for a perinatal psychosis storytelling project?
*
Yes! I am interested in sharing my story and learning more skills on how to!
No thank you, but I'd like to attend PPP storytelling events, so please let me know about it once you know more about them!
If you feel comfortable sharing, how long has it been since your perinatal psychosis experience?
If other opportunities come up, and you're interested in storytelling about your lived experience, what platforms would you like to be considered for?
Podcasts
Radio
Television Broadcasting
Trainings
Newspapers
Magazines
Blogs
Conference Panels
Anything that you would like us to know?