Tell Us Your Story!
Exit this survey 

1. Share Your Story...

 
When we meet with legislators we are often asked if there are people in their districts with MS. They want to know how many people have MS in their district and what are some of the issues/challenges they face.

This is your chance to tell your story! We are looking for people with MS, family members and friends to share their personal experiences with MS. With your permission, we will create personalized story cards that will be distributed to legislators to serve as an educational tool to help them learn about and join the movement to create a world free of MS.

If you are willing to share your story, please complete the questions that follow. Someone will be in contact with you to follow up on the information you provided and to get consent before we provide any information to legislators.

We appreciate your help in telling your story and helping to educate legislators about the challenges of living with MS.
*
1. What is your connection to multiple sclerosis?
2. Have you ever served in the military?
*
3. Please tell us how MS has impacted your life.
4. Are you (or the person you know living with MS) receiving or have recieved assistance from any of the following?
5. Have you (or the person with MS) experienced any of the following?
6. If you indicated experiencing an issue on the previous question, tell us about the issue.
7. What else should we know about your unique story?
8. Do you have any personal connections with Ohio elected officials?
9. Do you have insurance?
10. Have you ever been denied insurance due to a pre-existing condition?
*
11. For follow up purposes, please provide us the following contact information.