Share Your Story About Health Care Question Title * 1. Tell us your story. You can be as detailed as you need to, but the more information you can provide, the more helpful it will be. You can share stories about challenges you've faced, or examples of where things went well.In addition, if you would like assistance with a recent or ongoing issue involving insurance coverage or payment of a service, you can contact the Office of the Healthcare Advocate for free assistance. OK Question Title * 2. Would you like your comments to remain anonymous? Yes No OK Question Title * 3. Please enter any information you are willing to share. The demographic information is helpful for us to understand the challenges unique to different groups and in different parts of the state. At a minimum, your zip code is appreciated. Name Address/zip code Email/phone OK The following questions will help us to better understand how different types of families are being affected by Connecticut's health care system. OK Question Title * 4. What is your age? Less than 12 12-17 18-26 27-55 56-64 65+ OK Question Title * 5. What is your marital status? Single, never married Married or Domestic Partnership Widowed Divorced Separated OK Question Title * 6. How many people live in your household? 1 2 3 4 5 6+ OK DONE