We want to hear about how this pandemic is affecting the health and coverage of Californians.

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* 1. Name

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* 2. Zip code

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* 3. Email

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* 4. Phone 

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* 5. Has the COVID-19 pandemic changed your health insurance status or that of your family? In what ways?

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* 6. Have you received or attempted to receive testing or treatment related to COVID-19 but got an inflated or surprise medical bill? Tell us more about your experience below.

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* 7. Are you uninsured or underinsured and worried about health care coverage/costs during the COVID-19 pandemic? Have these concerns stopped you from seeking testing or treatment? Please describe more below. 

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* 8. Can we share your story? Don't worry, we'll contact you first.

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* 9. Would you like to receive regular updates and alerts Health Access?

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