SHARE YOUR STORY USING THIS FORM

 
 

You've probably landed here because you've been on a journey and want to inspire others. We know how hard you will have worked to get here, so huge congratulations. Knowing you are not the only one facing a particular issue can be a great help. Thank you for sharing your story, that will help others from North West London.

 
 
First Name*
 
 
 
 
Last Name*
 
 
 
 
Email Address*
 
 
 
 
DoB (dd/mm/yyyy)
 
 
 
 
Mobile Phone*
 
 
 
 
What type of diabetes do you have*
 
 
 
 
Which area do you live in*
 
 
 
 
Paste your story here (we ask that share your story is no longer than 300-500 words)
 
 
 
 

If you would like to add up to 2 appropriate photos to complete your story, do this here (please make sure you have permission to use any photograph you upload).
 

I understand that any photographs/filming/written text supplied will be made available for the purpose of promoting the principles and practices of the National Health Service (NHS) and other public sector or not-for-profit health and social care organisations.
I also understand that all or part of the photograph/filming/written text supplied may be used in conjunction with other forms of illustration and text within publications, journals, textbooks, email, app, advertising and websites.
I hereby give my informed consent for photographs/filming/interviews supplied to be taken and used by the NHS as set out above

 
 
I agree*
 
 
 
 


  
 
 
Upload your photo here (max size 10MB)
 
 
 
 

  
 
 

  
 
 
Upload a second photo