We want to know how you're feeling.
The Republicans have proposed changes to the Affordable Care Act
Do you understand the proposed changes to the ACA?
Are you concerned about losing your health care?
Do you have medical insurance?
Please, tell us your health care story.
Your answer
Would you be willing to tell you story?
Please provide your contact information (name, email and phone). *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms