#NoBodyIsDisposable Community Survey 2
Has someone that you care about died from COVID-19 for what could have been avoidable reasons -- due to lack of treatment because of higher weight, lack of access to treatment, triage, or lack of access to the vaccine? If so, please take this short survey by #NoBodyIsDisposable to help us advocate for our community and increase public awareness of our stories. We won't share any information without your permission.

Note: Some of these questions may be upsetting. Please take care of yourself.
Sign in to Google to save your progress. Learn more
If the person was higher weight, please share more about their size here.
Did this person have a disability? If so please indicate what disability.
Did this person have any medical conditions? If so please share more about their conditions.
If you are comfortable, please share the person's racial and ethnic background.
What is this person employed? If so, were they able to work from home or did they have to work in person?
Please share their story. What happened? What do you feel could have been avoided?
I give my permission for this story to be used anonymously for advocacy and media. (Note that some advocacy is public, so media could access your story that way, even if you choose "For advocacy only.")
Clear selection
Are you willing to speak directly to reporters about your story? If so please share your name and email address or cell phone number here.
Where are you located? Please include city and state
Would you like to stay in touch to hear about the results of this survey and what's happening next? If yes, please provide your email here.
Is there anything else you want us to know?
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