Loved One of a Recipient Form | Dakota Lions Sight and Health

Your Name

First name

Last name

Do you have a story prepared, or would you like some guidance?

Story Selection

I already have written my story

I would like help with writing my story

I have a video prepared

Write, or copy and paste your story here.

You can use one or more of the prompts below to help you get started.

Share your written story

Not sure how to begin your story?

You can use one or more of the prompts below to help you get started.

Explain what receiving a tissue donation meant to you or your loved one.

What major changes has your loved one experienced since receiving the tissue donation?

If you could speak with the donor or donor’s family, what would you like to say?

Link your video story here

Video Link

Please enter a full Vimeo or YouTube link, such as: https://www.youtube.com/watch?v=yourvideoid or https://vimeo.com/yourvideoid Make sure the video is public or unlisted so it can be accessed properly.

Upload Photos

Optional: Upload photos for your post’s gallery. In a later step, one can be selected as the profile picture.

Attach photos

Images are optional (5mb max)

Pick your illustration.

This will be displayed on our main story page.

Illustrations

Pick your main image

This will be displayed on our main story page.

Your contact information.

In case we need to follow up with you regarding your submission.  Any information you share will not be shared publicly without your consent.

Phone number

Name Permission

My first name can be share on this website

Communication Opt In

I want to receive future email regarding  news, events and stories

Can the donor or their family contact you? Choose one.

Yes, please forward the donor/donor family my contact information.

Send them the link to my story only.

No, I would like to remain anonymous.