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Physicians Questionnaire
MSSNY wants legislators to hear directly from New York Physicians about the challenges they face as medical practitioners. Personal stories are vital for enhancing our messages on issues of concern to the medical professionals, particularly to legislators who represent the area where those professionals practice.

We plan to gather personalized stories from physicians and medical students to print as flyers and articles that can be distributed to legislators and journalists. Opting in to share your stories is entirely voluntary. We value and respect your privacy, which is why your permission is needed for us to share these stories.

Email address *
Do you give the Medical Society of the State of New York permission to use the information you provided in any communications, marketing efforts, etc.? *
First Name *
Your answer
Middle Initial
Your answer
Last Name *
Your answer
Street Address (Voting Address) *
Your answer
Town/City *
Your answer
Zip Code *
Your answer
Email *
Your answer
Mobile Phone Number *
Your answer
County *
Specialty *
Your answer
Estimated Costs: Medical Malpractice *
Your answer
Estimated Costs: Property Taxes *
Your answer
Estimated Costs: Business Taxes *
Your answer
While not giving any identifying information about the patient, can you share any lifesaving stories? If yes, please include detailed stories and examples. *
Your answer
Do you have any uplifting or heartbreaking experiences in dealing with patients that might help convince legislators of the need to take certain actions? If yes, please include detailed stories and examples.
Your answer
While not describing identifying details about the patient, with your treatment and care, would you be willing to share you share any patients’ stories of helping patients overcome their sickness, diagnoses or diseases? If yes, please include detailed stories and details. *
Your answer
In sharing these stories, we would also like to know if the care you provide to your patients has been limited in any way by health insurance companies? If yes, please include a detailed example of issues you have had. *
Your answer
If you had the chance to speak to a legislator, what would be your top concerns? *
Your answer
Do you have any other stories/information you'd like to share? *
Your answer
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