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Share Your Story.
If you would like to publicly share your abortion experience story OR if you called our talkline and would like to leave feedback on your experience, fill out the form below. Please read the instructions for each answer by hovering your mouse over the question mark next to each label. Connect & Breathe reserves the right to reject stories that are not in line with our mission and vision.
*
Indicates required field
Name
*
Please list your name as you would like it to appear with your feedback or story. You may use only your first name, initials, or a nickname if you wish.
Email
*
We will NEVER share your email with another organization. We may reach out from time to time with Connect & Breathe updates or if we have a question regarding your story or feedback.
I Am
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Leaving feedback for Connect & Breathe's eyes only
Sharing my story for use on Connect & Breathe's website and social media accounts
Feedback / Story
*
Please provide comments regarding your call or your testimonial/story here. There is no required minimum length. Connect & Breathe reserves the right to trim or non-materially edit testimonials/stories that will be published as well as reject stories deemed inappropriate.
Story Title
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If you're sharing your story to be published, what title would you like it to have?
How Did You Hear about Connect & Breathe? Choose One
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Google Search
Facebook
Twitter
Instagram
Provider
Friend or Family Member
Other
If other, please list
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On a Scale of 1 - 5, how would you rate your call with Connect & Breathe?
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1 - Not at all helpful
2 - Slightly helpful
3 - Somewhat helpful
4 - Very helpful
5 - Extremely helpful
6 - Not applicable
Comment
*
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