#1000voices

Every voice collected, stands with us.

This is a short survey for supporters to share feedback and be part of a collective of 1000 voices.

Tell us more about your connection with SUDEP Action and how that connection has helped.

With over 700 voices already represented via the Epilepsy Deaths Register, we would love to hear from more of you. Every voice that stands together with us helps us to make sure every epilepsy death counts and that future lives can be saved!

It will take about 10-15minutes to complete and your answers will help us with future research, policy and marketing purposes in support of the national Prevent21 campaign.

If you would like your identity to be kept anonymous, then you don’t have to enter your name.

Please note, your responses may be edited for communication purposes.

Thank you for your time and support.

SUDEP Action

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* 1. Your name

First name

Surname

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* 2. Can you share the name of your loved one? (optional)

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* 3. What has being part of SUDEP Action meant to you?

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* 4. What has been the benefit of having SUDEP Action involved in your journey?

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* 5. What are some of the barriers you have come up against when talking to others - such as professionals, organisations, other individuals or during the inquest process?

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* 6. What do you think the challenges are for people who are bereaved by epilepsy in the future?

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* 7. What are the top three tips you would give to someone who is starting their journey?

Tip One

Tip Two

Tip Three

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* 8. Have you helped SUDEP Action via any of these avenues? (please select all that apply)

Epilepsy Deaths Register

Sharing My Story

Fundraising

Campaigning

Other (please specify)

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* 9. Are you happy for SUDEP Action to contact you in reference to the information you have provided above?

Yes

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* 10. We'd love to continue to share updates with you about our campaigns, services, fundraising activities and other charity news. To do this, we would like to determine your preferences below:
(If you've already provided us with consent recently, please leave this question blank. For more information on how we handle your personal data, please see our Privacy Policy.)

	Yes	No
Email	Email Yes	Email No
Post	Post Yes	Post No
Telephone	Telephone Yes	Telephone No

If you have ticked 'yes' to either telephone or post, please add those details below:

Don’t forget - at any point, you can change your preferences by calling our Data Secretariat at 01235 772850 or emailing info@sudep.org.
We never sell or swap details and you can opt-out at any time.