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Tech harms can include many negative impacts, from emotional to psychological to financial and beyond. Please mark any of the harms you or a loved one have experienced or are experiencing here:

Suicidal ideation and/or attemptsSelf harmEmotional distressDepressionSocial isolationMental declineMental illnessAdmission to a psychiatric institute or holdPhysical ailment(s)Financial lossesJob loss(es)Harm to professional reputationHarm to others (for example, stalking or harassing others)DivorceLoss of custody over childrenDiscrimination

Other: Please explain the harms if they are not covered in the list above.

Approximately, when did the harm(s) begin?

Please select the technology or technologies involved

AI chatbotSocial media platformDigital commerceAI browserCryptocurrency platformOnline gambling and prediction platformData center or infrastructureUnsureOther

If other, please describe

Do you have access to any information documenting the harm? (For example, but not limited to: chat transcripts, browser history, screenshots, emails, etc.)

Legal action?
YesNoUnsure

Policy reform?
YesNoUnsure

Public education?
YesNoUnsure

Community support?
YesNoUnsure

Please let us know, in your own words, how we can help?