Share your story
At HCW Hosted, we believe in amplifying the voices of health care workers and our families.
We invite you to use the form below to tell your story in written or audio recording form.
We will share it (anonymously or not, as you prefer) on social media channels and may use portions of it in media interviews and on our website.
Your Name (we won't share it publicly unless you grant permission)
How you wish to be credited when we share your story?
Initials only (for example, M.C.)
First Name Only (for example, Martha)
First Name, Last initial (for example, Martha C)
Full Name (for example, Martha Coolidge)
Preferred method of contact
Either is fine
Your Location (City, State, Country)
I am a
Family Member of a Healthcare Worker
I work / my family member works in a:
Long Term Care Facility
I am / my family member is:
Environmental Services Worker
I consent to HCW Hosted and its representatives sharing my story (anonymously or credited as I chose above) on social media, in media interviews, and on the HCW Hosted website. I realize that my story may be lightly edited for clarity, quoted in part, or used in full.
I would like to talk to someone from HCW Hosted about services for me and my family.
Yes, please contact me
There are prompts below to help you if you want them. But if they do not match the story you need to tell, ignore them. Tell us your story.
You can write your story below. Or, if you prefer, you record it and send it to us. If you prefer that option, please tell us in one of the fields below and we will be in touch.
How has your life changed since COVID-19? At work? At home?
What emotional, physical, or mental effects has COVID-19 had on you or your family members? What are you doing to cope? What are your family members doing?
How do you feel when you see the public not following masking, physical distancing, and other precautions to prevent the spread of COVID-19? What would you like to say to those folks?
What else do you want the public to know?
I have a photo I would like to have included with social media and media posts. It can be a photo of you or of something that represents your experience. We will contact you to get the photo. (Submitting a photo does not guarantee that we will be able to use it. Submitting a photo grants HCW Hosted and its representatives full rights to use the photo)
Thank you for sharing your story.
Send me a copy of my responses.
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This form was created inside of University of Arizona.