Please let us know how or if you would like your name to appear if we use your story.

By default, we will share the City/State that you provide to us if we use your story. If you would prefer to have your location remain anonymous, please select "No" above.

Tip: You can follow our format by answering these questions: Who are you? What is your connection to peripheral neuropathy? When and how were you diagnosed? What has been the impact of peripheral neuropathy on you? How have you been managing your peripheral neuropathy? What inspires you to face peripheral neuropathy head-on and how do you do it? What advice would you give to others going through the same journey? Or give us your own story in your own words and format.

By submitting your story/photo and clicking the checkbox above, you grant the Foundation for Peripheral Neuropathy permission to use your story, photo, first name, and city/state/country (if permission is granted herein) without any compensation to you for as long as the Foundation wishes to do so. The Foundation for Peripheral Neuropathy may use your story in whole or in part in print or promotional materials, on its website, its emails, its social media, or its communications. We will never publicly use your last name, email, or phone number. The Foundation for Peripheral Neuropathy has the right to edit or modify your submission without further approval from you. You release the Foundation of Peripheral Neuropathy and its employees, directors and agents from any direct, consequential or incidental damages or liabilities regarding use of the Submission and your name/location as designated herein. You confirm that you are 18 years or older.