Tell us: do you suffer from whooping cough?

“,”prompt”:Share your experience”, “displayOnSensitive”:false,”elementId”:c4ef1929-30f2-4f32-8d51-fc67cfbddad6″, title”Share your experience”, “isNonCollapsible”:true, “formFields”:( {“_type ‘model.dotcomrendering.pageElements.CalloutFormFieldBase’, ‘name’, name, ‘id’:164746508, ‘hideLabel’:false, ‘label’, Name”, “hidden”:false,”type”:text” required”:true},{“_type”:model.dotcomrendering.pageElements.CalloutFormFieldBase”,”name”where_you_live”,id”:164746509 “,”hideLabel”:false,”label”Where do you live?”,”hidden” :false,”type”text”required”:true},{“_type”:model.dotcomrendering .pageElements.CalloutFormFieldBase”,”name ‘tell_us_a_bit_about_yourself_age_and_what_you_do_for_a_life”,”id ‘164746510’, ‘hideLabel’:false’,label ‘Tell tell us something about yourself (e.g. your age and what you do for a living) “,”hidden”:false,”type”text”required”:false},{“_type”model.dotcomrendering.pageElements.CalloutFormFieldBase”name”name “tell_us_how_you_were_affected_by_whooping_cough__what_your_or_your_child’s_symptoms were,”description”: “Please provide as much detail as possible”, id ‘164746511’, ‘hideLabel’:false, ‘label ‘Tell us how you were affected by whooping cough – what were your symptoms ( or that of your child)? “,”hidden”:false,”type”textarea”,required”:true},{“_type”:model.dotcomrendering.pageElements.CalloutFormFieldBase”,”name”how_your_doctors_surgeon_touched_it_and_how_you_feel_now”, “description”: “Give so much possible details on”, id ‘164746512’, ‘hideLabel’:false, ‘label ‘How did your doctor’s office handle this; and how are you feeling now?”,”hidden”:false,”type”textarea”, “required”:false},{“_type”:model.dotcomrendering.pageElements.CalloutFormFieldBase”,”name” are_you_aware_of_other_cases_within_your_community_”, id “164746513”, “hideLabel”:false,”label “Are you aware of other cases within your community? “,”hidden”:false,”type”textarea”,”required”:false},{“_type”:model.dotcomrendering.pageElements.CalloutFormFieldBase”,”name”: if_you’re_lucky_you_can_upload_a_photo_of_yourself_here”, “id”: ” 164746514″, “hideLabel”:false,”label”: If you want, you can upload a photo of yourself here”, “hidden”:false,”type”:file”, “required”:false },{” _type ‘model.dotcomrendering.pageElements.CalloutFormFieldRadio’,name ‘can_we_publish_your_response’, ‘options’:({‘label ‘Yes, completely’,value ‘Yes, completely’ },{“label”: Yes, but please contact first me”, “value”: Yes, but please contact me first”},{“label”: Yes, but please keep me anonymous”, “value” Yes, but please keep me anonymous”},{“label” :No, this is information only”,”value”:No, this is information only”}),”id”:164746515″, “hideLabel” :false,”label “Can we publish your answer?”hidden”:false ,”type”radio”,”required”:true},{“_type”:model.dotcomrendering.pageElements.CalloutFormFieldBase “,”name ‘phone number’, description ‘Your contact details are helpful so we can contact you for more information. They are only seen by The Guardian.”,”id”:164746516″, “hideLabel”:false,”label” “Phone number”, “hidden”:false,”type”:text”, required “:false},{ “_type ‘model.dotcomrendering.pageElements.CalloutFormFieldBase’,name ’email_address_’,description ‘Your contact details are useful so that we can contact you for further information. They will only be seen by The Guardian.”,”id”:164746517 “hideLabel”:false,”label”Email address “,”hidden”:false,”type”text”required “:true},{“_type ‘model.dotcomrendering.pageElements.CalloutFormFieldBase’,name ‘you_can_add_more_information_here’,” description ‘If you include other people’s names, ask them first.’,’id’: “164746518”,”hideLabel”:false,”label “You can add more information here”, “hidden”:false,”type “:textarea”,”required”:false}),”_type” model.dotcomrendering.pageElements.CalloutBlockElementV2″,”tagName”:uk-callout-whoopingcough”, “activeFrom”:1714089600000,”id”:b3a7accd-a27c- 4356-92e6-0236433f527d”,calloutsUrl” https://callouts.guardianapis.com/formstack-campaign/submit”,”formId”:5747990},”pageId”:society/2024/apr/26/tell-us-have -you-been-impeded-by -whoopingcough”}” config=”{“renderingTarget”:Web”,”darkModeAvailable”:false,”assetOrigin”:https://assets.guim.co.uk/”}”>