TELL US YOUR STORY

MY STORY QUESTIONNAIRE

Please fill in the form below and provide as much detail as you feel comfortable with, ideally giving an email address so we can contact you if necessary.  

PLEASE NOTE - For the sake of brevity on this questionnaire, we have used 'stitching' to cover knitting, cross stitching or crochet.  

If your story is long, or you want more time to think about it, we suggest you write it up in Word first then copy and paste it into the allocated space below the initial questions.   

As an extra precaution we have included a Yes / No permission choice at the end.

About you :

Your Name:
Your Age:
Country:
Contact details:
Cross stitching:
Knitting:
Crochet:
Has stitching helped you with:
(Please fill as many or as few as appropriate)
Pain: Personal development:
Depression: Communication skills:
Fibromyalgia: Disruptive behaviour:
Panic: Concentration:
Anxiety: Fear:
Post traumatic stress: Loneliness:
MS: Meditation:
ME: Binge eating:
Dyslexia: Memory:
Stress: Weight loss:
Phobia Stopping smoking:
None: Alcohol dependency:
Other: Drug addiction:
(If so what?):  
 

Your Story:

Do you give us permission to publish details of, or extracts from your story as long as no contact details are included?