Follicular Lymphoma Foundation

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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.

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

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

What country do you live in?

Can you tell us a few words about yourself?

What stage is your FL? And what year were you diagnosed?

Can you walk us through the moment you found out you were diagnosed with FL?

Could you share more about your journey and experiences of living with FL? - What have been some of the biggest challenges and triumphs you’ve faced?

If you could offer support or guidance to others in the FL community, what would be the one thing you would 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 on their social media channels and website?

Yes - I provide my consent for the FLF to use my image and story on social media channels and the website. 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

Announcing: New funding of $2 million for research to get one step closer to a cure for Follicular Lymphoma.

Patient story request form

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