First Name

Last Name

Email

Where do you live (city/state/country - whatever you feel comfortable sharing)

How old were you when your symptoms began?

How old were you when you were officially diagnosed with endometriosis?

Do you have any other conditions related to or impacted by your endometriosis you feel comfortable sharing? (e.g., adenomyosis, infertility, etc.) (Limit of 500 words)

In your own words, please share your endometriosis story. You can tell us about your symptoms, diagnosis journey, treatment journey, etc. (Limit of 500 words)

How has endo impacted your life? (Limit of 500 words)

What would you want others to know about endo? This could be advice, words of support, etc. (Limit of 500 words)

Would you be willing to share photos or record a video to use with your story? Yes No

Do you give EndoFound and its authorized contractors permission to use your story, in whole or in part, for marketing, fundraising, and awareness purposes (including, but not limited to, print, email, video, social media, and web)? Yes No

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