Tell Us Your Story

We would love to hear and share your story of Eye Loss. Please fill out this form, and if you wish, add a photo of yourself. We have included a few questions that you may find useful as prompts.

Your First Name*
Your Email*
Enter Email Confirm Email
Your State & Country*
Tell Us Your Story Here
Here are a few questions that may help you: How long have you had your artificial eye? If you met someone today who was facing eye loss what would you tell them? Is there any information you wish you had right at the beginning that may have made things better for you?
Upload A Photo of Yourself, if you wish.
FileDescription
Please include a description or caption for your photo.
Consent & Agreement*
- I consent to ArtificialEyes.net publishing my story and, if applicable, my photo. I confirm the following:
This is my story of eye loss. I am happy for ArtificialEyes.net to publish my story in the hope that it helps others. This is a photo of me. I own the photo and am happy for ArtificialEyes.net to publish this photo of me.