Share Your Story

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First Name

Last Name

State/Province

Country *

How should we identify you if your story is shared publicly?

if pseudonym:

Your Story

Please select the option that best describes you (select all that apply): *

Please select the disease category: *

Other:

You can answer in as much or as little detail as you want. Skip any question.

In a few sentences, what do you want people to understand about your experience in neuro-complex conditions?

What has been the biggest barrier to care/access/support?

What helped you cope, adapt, or move forward?

If you could change one thing in music, healthcare, or society for people like you, what would it be?

Anything else you want to share (timeline, context, resources, reflections)?

Publication Controls: You decide what details (including diagnosis and location) may appear publicly if your story is featured. We will confirm your preferences before publishing.

*Please avoid including full names of clinicians, hospitals, or other individuals. If included, we may remove identifying details for safety and fairness.

Story & Media Release (Public Sharing Only)

By checking the box below, I grant InclusiVibe Foundation permission to use my submitted story and any materials I provide now or later (text, quotes, images, audio/video) for mission-related communications and education (website, email, social media, presentations, and related media). I understand I will not receive compensation. I understand InclusiVibe Foundation may edit for clarity, length, accessibility, and safety without changing the meaning. I can request that InclusiVibe Foundation stop future use, but removal may not be possible from third-party platforms or past distributions.

full release for your records will be sent to your email after submission

I agree to the Story & Media Release and confirm I am 18+ (or I am a parent/guardian authorized to consent).

Full legal name:

Date: *