Share Your Story With Elected Officials
With policy and legislation shifting the balance of access to reproductive care and medicine so rapidly, ASRM is seeking your voice about how insurance coverage, legislation, and policies on abortion, fertility, and personhood measures are affecting your practice and patients.

With your permission, these stories will be shared with elected officials to promote protective and comprehensive coverage for reproductive medicine.
 
We will not share any of your information without your express permission.
Sign in to Google to save your progress. Learn more
Email *
Your name *
The state/district where you practice *
How have you been affected by restrictions on reproductive healthcare and medicine? (select all that apply) *
Required
Please elaborate here: *
How has insurance- your patients' coverage, type, or lack thereof, reimbursements, prior auth, etc- affected your and your staff's ability to provide care? *
How has legislation restricting access to contraception impacted your ability to provide fertility treatment consistent with evidenced-based guidelines and/or to support your patients in making reproductive healthcare decisions?
 *
Is there anything else you'd like to share about how restrictions on abortion or fertility care have affected you, your practice, or your patients? Please share here:
What would you like people to know about your profession and the IVF process? (ie, what you think legislators should know about IVF.) *
Are there any patient stories (or stories from patients) you would like to share?
Can ASRM share your experiences with legislators? *
Can we share your story on social media? *
Required
My social media handles are:
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms