Share Your Stroke Story

Name
First Last
Address*
We like to send you gifts sometimes. 🙂

Street Address Address Line 2 City 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.
Sign up for our email list?*
- Yeppers!
- No thanks 🙁
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