We will decipher the imagery you describe and upload it to our archive. By filling in this form you consent to us collecting your memory to store safely, we will interpret this description ourselves using our remaining mind.
Name:
Age:
Describe your most recent memory:
This must include colours, location, significant features, textures, etc
Describe your symptoms:
Describe any symptoms present in the past 5 days
Do you feel real?:
Yes
No