Survey - An Act Establishing Emergency Medical Services for Veterans H.2765
We are seeking information from Veterans and their family members about their experiences with Emergency Medical Services. The results of this survey will be included in the public hearing on the bill in spring 2017, using only non-identifying information. Your input is important and will assist in documenting the need for An Act Establishing Emergency Medical Service for Veterans H.2765. For more information please visit
Are you a United States Veteran?
No - Family Member of Veteran
No - Friend of Veteran
Are you currently enrolled in VA Services?
Yes - service connected
Yes - Enrolled, not service connected
Are you a resident of Massachusetts?
No - Not a Massachusetts Resident
Yes - Barnstable County
Yes - Berkshire County
Yes - Bristol County
Yes - Dukes County
Yes - Essex County
Yes- Franklin County
Yes - Hampden County
Yes- Hampshire County
Yes - Middlesex County
Yes - Norfolk County
Yes - Plymouth County
Yes - Suffolk County
Yes - Worcester County
What is your age group?
65 and older
Prefer not to answer
What is your gender?
Prefer not to answer
Have you utilized Emergency Room services at any of the following:
VA Emergency Room
Non-VA Emergency Room
Type your testimonial here:
Please share your personal statement in support of Bill H.2765 and its importance to Veterans of Massachusetts. You can include information such as: your personal experiences with Emergency room visits, Emergency visit medical bills and whether the VA paid the bills or any other personal experiences you wish to share regarding Emergency Services for Veterans.
Do you authorize the use of the information you have provided as part of the supporting documentation presented during the public hearing at the State House in support of Bill H.2765. Testimonials will be presented using only non-identifying information.
Are you interested in attending the Public Hearing at the Massachusetts State House in Boston?
Yes - If you select yes, we will use the E-mail address you have provided above to notify you of the date of the public hearing.
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We appreciate your time and effort in sharing your experiences and your support of bill H.2765.
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