Share Your Story Climate & Health Question Title * 1. How does the climate or the environment affect your asthma? Are your asthma symptoms exacerbated by air pollution, extreme heat or cold, forest fires, etc? Are you impacted by longer allergy seasons? Is your asthma affected by mould caused by flooding? Do you feel climate change is making your asthma worse? Please share your story. If you have a child who has asthma, please share their story. OK Question Title * 2. Please enter your name and contact information. Your information will be kept completely confidential and will not be shared with external parties. Name City/Town State/Province Email Address Phone Number OK Question Title * 3. Can we contact you to find out more about your story? Yes No OK Question Title * 4. Can we share your story to create awareness about how climate change affects asthma? You will be identified by your first name and city of residence only. Yes No OK THANK YOU!