Share Your Story about a Vaccine-Preventable Disease

Everyone has a story to tell.
Together, we can provide a valuable lesson and share advice with others.

Our goal is to share your first-hand knowledge and experience with others throughout New England to help them avoid a similar fate. Your story will send a powerful message about the importance of vaccination.

We will share these stories on our website, in our newsletters, educational events or other related opportunities.

Learn more on the New England QIN-QIO website: http://www.healthcarefornewengland.org/initiatives/immu/

Question Title

* 1. What was your experience? Please be as detailed as possible.

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* 2. When did this happen?

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* 3. If you could give any advice, what would it be?

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* 4. Your Contact Information:
Please note, we do not share or sell any of your contact information

Your Name

Your Phone Number

Press the Blue ‘SUBMIT’ Button below to send us your story electronically.

Can I mail or fax my story to you instead?
Please print a copy of this page from your internet web browser and send to the following location:

By Mail:
Healthcentric Advisors
Attn: Russell Cooney
235 Promenade Street
Suite 500, Box 18
Providence, RI 02908

-OR-

By Fax:
401-528-3237
Attn: Russell Cooney

Question Title

Question Title

* 1. What was your experience? Please be as detailed as possible.

Question Title

* 2. When did this happen?

Question Title

* 3. If you could give any advice, what would it be?

Question Title

* 4. Your Contact Information: Please note, we do not share or sell any of your contact information

* 4. Your Contact Information:
Please note, we do not share or sell any of your contact information