Lived-Experience Story
*Insert Page Description*
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1.
First name:
(Required.)
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2.
First name sharing:
(Required.)
I would like to share my first name with my story.
I would like to share my story but not my name.
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3.
Email:
(Required.)
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4.
Phone Number:
(Required.)
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5.
PCM can contact me if they have any questions (*Please note that contact information is for PCM use only, and this information will not be shared publicly)
(Required.)
Yes
No
6.
Can you tell us about your lived experience with your mental health/addiction challenges?
7.
What motivated you to decide to make a change towards wellness/recovery?
8.
How did you begin to make changes?
9.
Can you talk about resources or coping skills that work for you and your mental health?
10.
What does your support system look like? (Personal/professional/community supports)
11.
How do you maintain your wellness/recovery?
12.
How have the changes you've made impacted your life?
13.
Is there anything else you would like to share?
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14.
By submitting answers to this survey, I consent to share my recovery story on PCM’s social media, in PCM blogs, on PCM’s website, and/or in PCM’s newsletter. I acknowledge that PCM is committed to protecting and respecting my privacy. I understand that if I would like to remain anonymous, PCM will protect my identity. I understand that pieces of my recovery story will be used as quotes, and PCM may not use every answer for each question in this survey.
(Required.)
I Accept.
I Decline.
