Participation in Media and Legislative Meetings Interest Sign-Up.

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

This sign-up form is for people wishing to participate in media interviews and meetings with lawmakers. We are getting more and more media requests, but a lot of them are very short notice and they would like local Longhaulers. Our state advocacy teams created under the COVID-19 Longhauler Advocacy Project are also landing meetings with representatives and senators, and we have also participated in meetings with our health agencies. A big part to the legislative side of this is that the legislaters want to meet with their constituents, and many will not take meetings unless we have someone in their district.

For all of the reasons listed above, we are trying to create an easily accessible document that allows us quick access to Longhaulers, Medical Providers and Researchers, Caretakers, Long COVID Kids etc... to ensure we can participate in these opportunities and make it a lot easier on me and the rest of us to contact people on the fly if need be! If you are interested in any of the above, please complete the form below. You are welcome to and encouraged to share this and get others to sign up as well.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If you are interested in participating in the state advocacy team initiatives, you can sign up here: https://docs.google.com/forms/d/1RI7R2TI-IcL_iOCDfFa4d1WWzNKdnQ2_hTcYlwXPiHc/edit

Once you sign up for the state advocacy team, please then choose a team role. You may chose multiple: https://docs.google.com/forms/d/18V1s8ibaaZeQtWMzy1PWlUKXRPb87rjl110jb-QG9qw/edit

Assuming most filling this out are members of the COVID-19 Longhauler Advocacy Project, but if not, join here:
https://www.facebook.com/groups/Covid19LonghaulerAdvocacyProject

State (spell out) *

County (spell out) *

District (Example: Fl-22) look up if you are unsure here https://www.census.gov/mycd/ *

Your name (First Last) *

Most accessible phone number to contact you at *

Most accessible email to contact you at *

Please select all that apply to you. (if you are a longhauler who is a first responder, etc, please select each) *

Longhauler

Medical Provider

Caretaker of a Longhauler

Researcher

First Responder

Parent of a Long Covid Child

Teacher

Required

please provide more about your selection above **briefly** (example: sick 15 months, infected as a first responder, investigating xyz in research) *

Some common topics.....please select all that you would feel comfortable discussing *

Vaccination as a Longhauler, getting better or worse, apprehensions, positives, negatives etc

Loss of income, job loss, reduction in hours

Inability to meet and pay bills. mortgage, rent, utilities, car, insurance, etc

mental health - we ask that you please understand and support our stance that Long COVID is not psychosomatic or anxiety. We ask that you emphasize medical gaslighting and inability to obtain answers and treatment leaving us with little to no hope of recover is the cause of any anxiety, depression, ptsd etc.

Being a Long COVID child or parent of a Long covid child, inability to attend school, not doing well in school, unable to participate in normal childhood activities etc

medical gaslighting, access to care, quality of care

quality of life, disability

the importance of patient led research and the long covid support groups, especially ours

lack of education and information surrounding long covid

workers comp, short term and long term disability and issues with obtaining it, denials, etc

POTS

ME/CFS

AUTOIMMUNE DISEASES

FIBROMYALGIS AND OTHER CHRONIC PAIN CONDITIONS

MCAS

SMALL FIBER AND OTHER NEUROPATHIES

ORGAN DAMAGE

NEURO ISSUES

CARDIOVASCULAR ISSUES

RESPIRATORY ISSUES

GI ISSUES

RENAL AND HEPATIC ISSUES

DERMATOLOGIC ISSUES

post covid care centers/ centers of excellence

the importance of ongoing advocacy efforts, what its like to be an advocate while so sick

social life- how has it changed, have you lost friends and familiy, are you worried about going out

masks- mandatory, optional, vaccinated vs unvaccinated, use in schools, use in public places

reinfection and infection after vaccination, antibodies- developed or didnt

legislation, presented or upcoming bills, why they are important/ needed

supplemental income, food stamps, medicaid, forgiveness programs, assistance programs

feedback on new guidance released by health organizations

response to political remarks or actions surrounding covid

Required

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

Forms