1. Registration

We are pleased that you have decided to join the Pennsylvania Campaign for Better Care. Please complete the following questions to join and you will receive follow up within one week from the Consumer Health Coalition about the work of the campaign.

* 1. Please provide the following information:

* 2. I would like to (Please check as many as you like):

* 3. Tell us your story. What challenges do you experience with the health care system? Is the current system serving your needs or those of the person you care for? What impact has your experience had on your daily life?

* 4. Tell us what you need most from our health care system to meet your needs or those of the person you care for:

Thank you for signing up for the Pennsylvania Campaign for Better Care. We will be in touch with you soon!

Contact:
Ted Zimmer
Community Organizer
Consumer Health Coalition
www.consumerhealthcoalition.org
650 Smithfield St. Suite 2130
Pittsburgh, PA 15222
 
100% of survey complete.

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