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We believe you.

You are worthy of healing.

You are worthy of self-compassion.

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Your Private Space

The text box is private to you. We cannot view it.

Your Choice, Your Control

All responses are optional. All questions can be skipped.

This space is for you. If you just want to click ‘Submit Log’ without answering any questions, you are welcome to scroll to the bottom and do that.

If you choose to answer any optional questions, it will take you about 5 minutes to complete.

This is your private text box.

We cannot access or view your private text box. You can choose to leave it blank or write as little or as much information as you like. If you leave it blank, you can still return with your unique access code to read, edit, delete, or add more.

All of the following questions are optional.

You can choose 'Prefer not to say' or skip any.

The optional answers are not linked to your private text box.

If you choose to return to your private text box, you will only see your private text box without the optional questions.

We are asking optional questions because we are aiming to better understand the barriers different survivors face to reporting and seeking medical, mental health, and legal services.

Would you like to answer an optional question about whether it happened within the past year or more than a year ago?

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Optional Feedback

The space below is optional if you would like to share feedback.

Is there an organization that supports survivors that you'd like to see us partner with?

Do you have any other comments or suggestions?

Before You Submit

By checking the box below and submitting your log, you confirm that you understand and agree:

You must be at least 18 years old to submit a log.
You do not have to answer any question.
Your private text box is for you.
Log Now Decide Later and partner organizations do not have access to and cannot read your private text box.
Optional answers are stored separately from your private text box and are not designed to be linked back to it.
Responses to optional questions can only be viewed as combined totals after 10 logs have been received.
This is not a report to law enforcement, a school, Title IX, a medical provider, a court, or any authority.
We will not contact you.
You will need your access code if you want to return to your private text box.
If you lose your code, we cannot recover it or restore access to your private text box.
You have read and agree to the Terms of Use and Privacy and Security Policy.

I understand and agree, and I want to submit my log.