Share Your Story with Cover Alabama

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Have you ever gone without health coverage or skipped care you needed? Or do you currently have Medicaid or Marketplace (ACA) coverage that’s made a big difference for you or your family?

Your experience matters. Lawmakers need to hear real stories from Alabamians about how health coverage — or the lack of it — affects our lives.

When you share your story, you help make the issue real for people and clearly show what's at stake if we don't take action. With this form, you can write your story, record your story, or request an interview, and it will only take about ten minutes to complete.

By submitting this form, you give Cover Alabama permission to share basic details of your story and use your likeness and image to promote health care access in the state. A member of our team may also follow up with you to discuss additional details about your story. If you have any questions prior to completing the form, or if you have any issues with the form, please contact us at coveralabama@alarise.org

What is your name? *

What is your phone number? *

What is your email address? *

What city do you live in? *

What is your zip code? *

Whose story are you sharing? *

I am sharing my own story.

I am sharing the story of a family member.

Other:

Race/Ethnicity (Optional - Check all that apply

American Indian or Alaska Native

Asian American

Black or African American

Latino or Hispanic

Native Hawaiian or other Pacific Islander

White

Other:

What is your gender?

Female

Male

Non-binary

Prefer not to say

Other:

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I am a: (optional - check all that apply)

Parent of child(ren) under 18

Grandparent

Small Business Owner

Veteran

Caregiver of a parent, child, sibling or other family member on Medicaid

Health care worker

I want to share my story with other Alabamians by: *

Sharing a brief written version of my story

Recording a brief video of my story online

Recording an audio version of my story on my cell phone or other device

Being interviewed by someone from the Cover Alabama coalition (phone or Zoom)

Required

Please tell us about your story. *

Submit

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This form was created inside of alarise.org.