Affordable Care Act Discrimination -- Reporting Form

We are collecting stories from LGBTQ Georgians who believe they have experienced discrimination in attempting to access healthcare.

Please use the below questions to tell us about discrimination you have experienced.

After filling out these questions, you may be contacted by a member of our team.

    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    Must be fewer than 1500 characters.
    This is a required question
    This is a required question
    Must be a valid email address
    This is a required question
    This is a required question