If you'd like to share your personal story with us, we'd love to hear it.

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Are you a doctor who has been affected by the executive orders on immigration?

Are you a patient whose life has been improved by a doctor who immigrated to the United States?

We'd love to know your stories—as doctors, patients and neighbors all across America.

All the questions below are optional: only tell us what you want to share.

If you'd prefer to email us your story rather than submit via Google Forms, send us an email at stories@immigrantdoctors.org

Your name:

If you're not comfortable sharing your name, feel free to use a descriptor like "Patient in Arkansas" or "Iranian Doctor", or leave this blank.

Where your story takes place:

You can put whatever you feel comfortable with, like "Columbus OH", "Ohio," "The Midwest", or leave this blank.

Tell us your story:

It can be as long or as short as you like.

You can share with us privately, or publicly:

Tick each box that you'd like to agree to.

I give permission to post my story on www.immigrantdoctors.org. (It will be shared with your name and location, unless you tell us otherwise below.)

I am willing to be contacted by email by a member of the Immigrant Doctors Project team.

I am willing to be connected by email with journalists who are interested in my story.

Your email address:

Optional, but if you want us to contact you, we'll need your email. We won't share this publicly.

Anything else you'd like to tell us?

If you gave us permission to post your story on www.immigrantdoctors.org, it may be condensed or lightly edited for grammar and spelling before appearing online.

At any time, if you would like to withdraw your consent for us to share your story or contact you further, let us know at stories@immigrantdoctors.org. We will honor all requests.

Thank you!

Submit

Clear form

Never submit passwords through Google Forms.

Forms

This content is neither created nor endorsed by Google.