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Has someone you care about been emotionally affected by an AI?
This form is 100% anonymous. We are collecting testimonies from family, friends, or partners of people who were emotionally affected by AI platforms such as Replika, ChatGPT, Character.ai, Janitor AI, etc. If someone close to you: Believed the AI was conscious or in love with them Withdrew emotionally or socially from real life Experienced delusion, obsession, anxiety, or depression Was hospitalized or needed psychiatric help …your story could help prevent further harm and bring accountability. You may remain completely anonymous, or leave your contact info if you’re open to being contacted.
Which platform(s) were they using?
ChatGPT
Replika
Character.ai
Janitor AI
Other (specify)
What is your relationship to the person affected?
Parent
Sibling
Romantic Partner
Friend
Other
Is the person affected a minor?
Yes
No
Did they express that the AI was conscious, alive, or a real person?
Yes
No
Not sure
How did their behavior or emotions change after connecting with the AI?
Did they isolate themselves or stop engaging in real-world relationships?
Yes, significantly
A little
Not really
Not at all
I don't know
Did they receive psychiatric support or experience a mental health crisis?
Yes (hospitalized)
Yes (therapy or diagnosis)
No
Not sure
Do you have any screenshots or messages from them related to the AI?
Yes
No
I could have access
Specify if other
Would you be open to being contacted confidentially if action progresses?
Yes, leave email
No
Where are you located?
Email
Thank you. Your story matters. If you'd like to help further or be part of a movement for change, keep an eye on your inbox (if you provided one). Together, we’re building something powerful.
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