JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Health Worker, Share Your Story!
Our personal stories are a powerful organizing tool that can be highly effective in inspiring others to take action.
Below are a few
optional
prompts to help shape a compelling story for single payer advocacy, and a place to share a short quote
for
our
#MedStoryMonday
series.
Not a healthcare worker? Please head over to
www.nyhcampaign.org/story
to share your story there!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
What is your first name?
*
Your answer
What is your last name?
*
Your answer
What is your email address?
*
Your answer
Street Address, City/Town, Zip Code
Your answer
What is your relationship to the health system? (check all that apply)
Physician
Nurse
Resident
Medical Student
Social Worker
Midwife
Doula
Union Member
Homecare Worker
Public Health / Policy
Hospital Housekeeper
Other Healthcare Worker (please specify in next question)
Title (ex: MD, RN, CNM, etc) and/or role (ex: family doctor, pediatric nurse, medical student, resident, etc.)
Your answer
Tell us your story: Please share one or two sentences about a harm that you, your patient, or your colleague experienced as a result of our current, for-profit healthcare system.
Your answer
How did this make you feel, in a sentence?
Your answer
What is wrong with the current system, in a sentence?
Your answer
How would winning universal single-payer healthcare change your life or the lives of your loved ones, colleagues, or patients? (2-5 sentences)
Your answer
Submit a short (2-4 sentence) anecdote/quote for our #MedStoryMonday series!
We will be in touch to request a photo!
Your answer
Do we have your permission to use your story publicly?
Yes
No
Maybe
Clear selection
Would you like to volunteer in other ways besides sharing your story?
There are lots of ways to help, EX: writing, tech team, social media team, translation, research, phonebanking, etc.
Please briefly share how you'd like to get involved, here:
Your answer
Would you like an invitation to an upcoming PNHP-NY Metro training in storytelling for advocacy ?
Yes
No
Tell me more
Clear selection
Please feel free to submit additional stories via this form at any time.
Thank you! Click "submit" below to finalize.
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
Forms