StoryTeller Call Out Form

Thank you for your interest in sharing your story to help Endometriosis Australia raise awareness about endometriosis. We value hearing from people with lived experience.

Please fill out the below form:

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* 1. Name

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* 2. Email

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* 3. Age

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* 4. City

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* 5. Do you identify with any of the following?

LGBTIQ+ community member

CALD background

Refugee or Migrant Background

Lived experience with a disability

From a rural or regional community

An adolescent or young adult

A member from a group that has historically faced barriers to care

None of the above

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* 6. Which area best describes the focus of your story? This will help us share your story in the right place - (mark only 1)

Friendships, Family & Relationships – stories about how endometriosis impacts personal connections.

Workplace & Career Journeys – navigating jobs, career changes, or challenges at work.

Medical Journey & Treatment Pathways – diagnosis journeys, treatment experiences, or healthcare challenges.

Everyday Life & Personal Triumphs – stories about resilience, hobbies, lifestyle, or day-to-day wins and hurdles.

Other (please specify)

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* 7. Have you experienced any barriers to treatment, such as access to healthcare or cultural taboos within your community making it difficult to discuss endometriosis or painful periods (e.g. religious, social, or cultural pressures)?

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* 8. Has endometriosis ever impacted your work or studies, like needing to change jobs or roles, missing exams, or putting your career or education on hold?

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* 9. What has your experience been with getting medical support? Can you tell us about any experiences (positive or negative) you've had with medical professionals such as doctors, nurses, etc on your endometriosis journey?

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* 10. Please share your story with us: Has endometriosis impacted your relationships, your career or studies, your journey through doctors and treatments, or even your day-to-day life? Whatever your experience, big or small, we’d love for you to share it with us.

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* 11. What support systems made the biggest difference for you during your toughest times?

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* 12. What keeps you going on the hard days? Is there a belief, habit, or personal motto that helps you live your best life?

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* 13. If you could speak directly to decision-makers within government, health departments, or medical bodies, what would you ask them to change, fund, or prioritise to improve the lives of people with endometriosis?

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* 14. Are you comfortable to share a photo of yourself? Would you be willing to participate in photo or video shoots?

Yes, comfortable sharing photo

Yes, open to participating in photo shoots

Yes, open to participating in video shoots

Not comfortable with sharing image

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* 15. Upload the image you'd like us to use to share your story.

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* 16. Do you consent to being contacted by Endometriosis Australia, Endometriosis Australia using your story/ image for promotional purposes such as awareness raising/fundraising, and Endometriosis Australia collecting and storing your responses, including any personal information you provide, for the purpose of research and improving our services and marketing information?

Yes I consent

No I do not consent

To share your story, we’ll need your consent. Please take a moment to read through this
document, sign it, then upload your signed copy.

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* 17. Please upload your signed consent form here

If you have any questions or are unable to complete the form, reach out to social@endoaustralia.org

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