Help Improve Medicaid for Illinoisans!
Please fill out this form to let us know ways you can be involved! Graciela Guzman, Coalition Manager, will be in touch with you to get you materials and resources! Protect Our Care Illinois is beginning work to reform Medicaid Enrollment and Renewal Systems. Please join us in making sure Illinoisans have access to the care and benefits they need to stay healthy.

For questions: Graciela Guzman, 773-270-2611,

Email address *
Name *
Your answer
Phone Number *
Your answer
Organization Represented (if any) *
Your answer
What are ways you are interested in getting involved? *
Is there anything you would like to share with us?
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service