Share your Story
Help us Celebrate Casa's 10 year anniversary by sharing your most memorable Casa experience.
Your name will be used to verify your relationship with Casa and will remain private unless you check the box giving us permission to share it along with your story.
First and Last Name:
What is your relationship with Casa:
Current or former patient
Current or former staff
Current or former volunteer medical provider
Current or former non-medical volunteer or intern
Please use the space below to share your story about your experience with Casa:
Can we share your story publicly as a part of our 10 year anniversary celebration:
Yes, you can share my story
Yes, but only if you keep my name and details anonymous
No, I would rather keep it private
If you are open to us using your story, would you also be open to any of the following:
Allowing Casa staff to contact me for additional details about my story
Having my photo taken to go with the story
Recording a video of me telling the story
None of the above.
Is there anything else you would like to share with us? Or do you have any questions we can answer for you about this project?
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Saint Louis University.