We want to hear your perspective!

 

Are you interested in joining a community where your voice is heard?

 

We want to help you fight unfair gaps in your treatment. Connect with our team to share your experience so that we may stand #togetherfortreatment. 

Share Your Story

 

* Name

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* Email

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Phone



* State



Zipcode



Please check all that apply.



If you, or your loved one, have a specific diagnosis, please share it here.



What are three words that describe you? For example, bubbly, advocate, student, chief, baker, mom/dad/aunt/uncle/grandma/grandpa.



What are three aspects of your life that bring you joy? Ex: Work, a morning cup of coffee, family.



Have you (or someone you care for) ever had trouble with your treatment? This could be prior treatments not working, doctors not listening, insurance issues, or problems paying for your treatment. Please tell us as much as you feel comfortable.



Tell us a bit about the perspective you hope to bring to your story, and why you are sharing your story.



Our motto is "Together for Treatment." Can you complete the phrase: "Alone, I/we.... Together I/we..." For example, "Alone, I struggle. Together we succeed." We use this to share the value of coming together on our website and promotional materials.



Confirmation checkbox is required.

 

 

Please note - Your words are confidential until you have connected with staff and choose to sign a release of information.