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Share your amazing story
We want to hear from you…The incredibly awesome tremendously excellent STROKE SURVIVOR! We want to hear YOUR voice. If you need assistance, that is totally cool, we understand.
Name
First
Last
Address
*
We like to send you gifts sometimes. 🙂
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Email
Date of your stroke
*
Date Format: MM slash DD slash YYYY
How old were you when you had your stroke?
Do you know what kind of stroke you had?
Any known reasons for your stroke?
What were your symptoms? What were you feeling during your stroke? Tell us the story of what happened.
Were you administered TPA (Tissue Plasminogen Activator) within the first 3-5 hours of your stroke?
Yes
No
Don't know what that is.
Where did you go for in-patient rehab?
Where did/do you go for outpatient rehab?
Any therapy tips you picked up during your time in therapy that might help others?
What are your biggest challenges/residual effects?
What advice would you give someone recovering from a stroke now?
What keeps you motivated now?
Post recovery, what is something you have learned that might encourage others?
What is something quirky/fun about yourself? Any hobbies?
What's your favorite motivation song?
What's your Instagram handle? You don't have to share, but other young stroke survivors could follow you!
How did you find out about NOPW?
Please attached a good quality photo of yourself that'd you would like to use for your story. See other stories for examples.
*
Accepted file types: jpg, gif, png.
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