The Alliance for Fertility Preservation Patient Advocate Survey

Please share your family building story so we can educate lawmakers about the need for infertility insurance coverage! We are working in states across the country, and we need your help.

Please take a moment to complete the survey below and let us know if you would like to stay informed or become engaged in these advocacy efforts.

The AFP is working with the Building Families Coalition and dedicated groups of patients, reproductive specialists, and oncology professionals to advocate for better coverage for fertility preservation and for post-treatment infertility services. We welcome your involvement!

Please note your information will be kept confidential and only used with your express permission.

Question Title

* 1. Please provide your contact information.

Name *

Address

Address 2

City/Town

State/Province *

ZIP/Postal Code

Email Address *

Phone Number

Question Title

* 2. Were/are you a cancer patient undergoing medical treatment that may cause infertility?

Yes