Story Collection Form

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Have you or someone you know struggled with affording their medication or experienced problems with a Short-Term Limited-Duration health insurance plan? Share your story with us and help us raise awareness on why we need legislation to create a more accessible and transparent healthcare system.

By submitting this form, you are giving Citizen Action/Illinois permission to use the information below (name, city, affiliation, and quote) in our advocacy work.

If you have questions, please contact Anusha Thotakura, Deputy Director of Citizen Action/Illinois, at anusha@citizenaction-il.org or (847) 790-2423.

Name *

Phone Number *

Email *

Address Line 1

We ask for your address so we can look up your legislator information.

Address Line 2

City, State, Zip *

Which of the options below do you identify with? *

Patient (personal experience with healthcare affordability)

Healthcare Professional (work with patients and have seen the impacts of high healthcare costs)

Advocate (passionate about healthcare affordability, no personal experience with healthcare cost challenges)

Affiliation and/or Title

If you have an organizational or professional affiliation, please share here.

Quote *

Please share a personal quote about why healthcare affordability, and specifically prescription drug affordability, is important to you. Some of these stories will be shared with legislators and the media, so please do not include any information you would not like public.

Comments/Questions

Would you be interested in working with Citizen Action to submit a letter to the editor to your local publication?

Yes

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