Share Your Planned Parenthood Gulf Coast Story
Have you accessed care at Planned Parenthood health centers in Texas or Louisiana or has Planned Parenthood impacted your life in any way? If so, we would love to hear and share your story.

Stories may be posted on our website, social media, or other public place (you can choose to be identified or not) for others to read. Sharing your story will help ensure that Planned Parenthood will continue to be there for the women, men, and teens who depend on us for everything from birth control, HIV and STI testing, cancer screenings, abortion care, comprehensive sexuality education to legislative advocacy and more. With anti-choice politicians determined to take away access to healthcare, it's never been more important to share your story and show that Planned Parenthood is a vital organization in our community.

After submitting your story we may contact you to ask about further sharing your experience. Your contact information will not be released without your permission and you're under no obligation to share more than you are comfortable with.

Fill out the form below to share your story about where you would be without the support of Planned Parenthood.

First Name *
Your answer
Last Name *
Your answer
Email *
Your answer
Phone Number
Your answer
City *
Your answer
State *
Your answer
Birth Year *
Your answer
Gender Pronouns
Ethnicity
What name do you want your story to be published under? State "Anonymous" if you want to remain anonymous. *
Your answer
Your Planned Parenthood Story *
Your answer
Were you a Medicaid patient when you received care at Planned Parenthood?
Would you be willing to have your photo taken to accompany your story? *
Would you be willing to be filmed telling your story? *
By clicking "I agree" you agree that: You are 18 years or older. You confirm that you have written your submission yourself. You give Planned Parenthood Gulf Coast permission to use your submission or any portion of it for current or future Planned Parenthood fundraising, advocacy, or media outreach projects, including possibly sharing your words with a variety of audiences, media, or publications. If we decide to share your story, your statements will appear along with the name indicated above, your city, and your state. If we want to share additional information we will contact you. You give Planned Parenthood permission to contact you for further authorization or if we have any questions about your submission or this authorization. In sharing your story, please keep in mind that your story — including your name if you provide it — may appear in public advocacy projects. Even if you do not provide your name, keep in mind that some information can reveal who you are, such as unusual details about you or others. *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service