You must have Javascript enabled to use this form. 1 Start 2 Complete Raising awareness of sepsis through story-telling Action on Sepsis Podcast is a patient-led podcast series focused on telling the whole journey of Sepsis from the perspective of the patient, along with input from healthcare workers, researchers, and other individuals advocating for improved sepsis care nationally and globally. The focus of the podcast is to showcase a diverse collection of stories and use knowledge from research and clinical fields to support learning from these stories. We are looking for individuals who are well informed about their journey with sepsis and are interested in sharing their experience in a professionally produced podcast. If you are interested, please complete the form below in as much possible detail. The deadline to apply is June 30th, 2021. Name * Email * Please enter your email. This will only be used to contact you regarding participation in the podcast. Life before sepsis Please provide a short description of your daily life before sepsis. For example, this can include your occupation or key interests. * Experience with sepsis Please briefly outline your sepsis story, including what happened prior to the diagnosis / hospital admission, details from your hospital stay, and impact on your friends/support network. * Life after sepsis How has sepsis impacted your life? What long-term impacts has it had on your health and well-being? Have there been recurring episodes of sepsis? * Interested in future projects? If we are unable to feature you in the first season of our podcast, are you interested in sharing your story on our website, through social media, or in future seasons? Yes No Leave this field blank