Share Your Healthcare Experience!

Please use the questions below to tell your story about your healthcare experience, both good and bad experiences. Please include only the information you are comfortable sharing.

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* 1. Who is this story about:  
(You, Friend, Relative, etc.)

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* 2. What happened?

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* 3. What examples can you give of when things went well with your (or your friend/relative’s) care?

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* 4. What are examples of how your (or your friend/relative’s) care could have been better?

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* 5. How did the doctors, nurses, etc., affect your (or your friend/relative’s) experience?

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* 6. How did you feel about the care delivered?

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* 7. What do you want others to learn from your story?

Sharing Your Story

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* 8. Would you be willing to briefly share your story on a live webinar attended by healthcare providers?

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* 9. Would you be willing to allow us to video record you telling your story?

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* 10. Would you prefer someone else narrate your story, with your input and final approval?

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* 11. Please enter your contact information below so we can reach out should we have additional questions.

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