Home » Your Support Hub » Your Voice » Your Voice Form

Patient story request form

Thank you for volunteering to share your story. Below are a series of questions to help guide you with writing your story. Don’t worry if you can’t fit everything in, we’ll be in touch for more information. If you have any questions, please contact us at info@theflf.org.

Your name? (We will only share your first name on the story).

Your email address? (for internal use only – we will not share this information)

What country do you live in?

Please tell us about yourself (job, hobbies, family life etc)

What stage is your FL?

And what year were you diagnosed?

Can you tell us about the moment you found out you were diagnosed with FL?

Are you having treatment or on watch and wait?

Have you experienced a relapse? If yes, please tell us how you have dealt with it.

What have been some of the biggest challenges and triumphs you’ve faced?

Could you share more about your journey and experiences of living with FL? -

If you could offer support or guidance to others in the FL community, what would you want to share with them?

Please provide one or two images to accompany your story.

Permissions

1. Do you prefer to have your name and photo(s) used with your story, or would you prefer to remain anonymous?

Yes – happy to have my name and photo(s) used No – do not use my name or photo(s) I would like to remain anonymous

2. Do you provide consent for the FLF to use your image and story in their materials, including social media, email, and on their website?

Yes - I provide my consent for the FLF to use my image and story in their marketing materials No - I do not provide my consent

3. We may create some videos of patient stories; would you be willing to be filmed talking about your experience?

Yes – I would be willing to be filmed talking about my story No – I prefer not to be filmed talking about my story

4. Would you like to receive email updates from the FLF?

Yes - I would like to receive email updates from the Follicular Lymphoma Foundation No - I would not like to receive updates.

Is there anything else you would like to tell us?

We will only use the information you provide for the purposes of contacting you about your story. For more information on how we look after and use your information see our privacy policy. By submitting this form, you agree to our data collection terms as detailed in our Privacy Policy. You can unsubscribe from communication with us at any time by emailing us at info@theflf.org.