Take the Patients Over Profits pledge!
Please fill out this form to take the first step in affirming the "Patients Over Profits" pledge.
The pledge states: "I pledge that I will not take contributions over $200 from executives, lobbyists, and PACs affiliated with the hospital, insurance, and pharma corporations within the corporate front group, Partnership for America’s Health Care Future, and instead pledge to put the health, well-being, and safety of my constituents over corporate health industry profits."
By taking this pledge, the candidate or elected official agrees that they will not knowingly accept any contributions over $200 from the executives, lobbyists, or PACs of organizations and corporations that have chosen to bankroll an effort to halt any attempts at health care reform. These corporations, which directly profit off of the pain, suffering, and, in the worst cases, death of patients, use those same profits to purchase political influence in an attempt to defend a wasteful system that is failing tens of millions of people. This pledge does not apply to rank-and-file workers who are employed by organizations associated with the Partnership. This pledge also does not include local Chambers of Commerce associated with the Partnership.
Please see the last question on this form regarding the additional verification that is required to take the pledge.
If you have any questions about the information found here, please email
or visit PatientsOverProfits.org.
Name of pledge signer
Current Office (if applicable)
Staff name + title (if you do not have staff, please list your own name)
Staff mobile # (if you do not have staff, please list your own mobile #)
Staff email (if you do not have staff, please list your own email)
URL of the posted pledge verification (can be social media or website):
To verify that you have signed the pledge, please include a link in response to the above question that features the pledge language on an official social media account, website OR email a photo of the signer signing a copy of the pledge to
. A printable version of the pledge is available here (
) to physically sign. NOTE: you must submit photo/video verification of the pledge in addition to signing this form.
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