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About You

Thank you for sharing your story and being part of HG progress. By entering your information and allowing the HER Foundation to share your story, we are able to educate others on the need for improved care, grant funding for expanded research, and reach more people by putting a real story to the diagnosis of Hyperemesis Gravidarum or HG. 

You must agree to the Media Policy at the end in order for us to use your story. 

Note: By filling out this survey, you are granting HER permission to use your story for any HG-related purpose. You may choose if you would like your name and details such as losses to be withheld for privacy. Do not include other personal details you do not want public.
1. About You:
This question requires a valid email address.
2. You may share the following publicly and in conjunction with any/all information, content and digital media about me: *This question is required.
3. What is your race?
4. What is your highest level of education completed?
6. What type of medical insurance/payment did you have during your pregnancy?
7. Please list the number of:
You may also share your story by video/conference call. See our interview page for more details. This page also gives you a list of questions that may help shape your story. 
12. What complications if any did you also experience:  *This question is required.
13. What additional complications did you or your child experience? *This question is required.
14. Would you like to share more about the impact and experience you had with these complications due to HG? *This question is required.
17. How did the HER Foundation help you during your pregnancy? Check all that apply.
  *This question is required.
20. What type of education, awareness or advocacy work would you like to do?
23. Any photos, creative content, or video you would like to share? For larger video, use WeTransfer and email us the link.