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 to share your story there!
Sign in to Google to save your progress. Learn more
What is your first name? *
What is your last name? *
What is your email address? *
Street Address, City/Town, Zip Code
What is your relationship to the health system? (check all that apply)
Title (ex: MD, RN, CNM, etc)  and/or role (ex: family doctor, pediatric nurse, medical student, resident, etc.)
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.
How did this make you feel, in a sentence?
What is wrong with the current system, in a sentence?
How would winning universal single-payer healthcare change your life or the lives of your loved ones, colleagues, or patients? (2-5 sentences)
Submit a short (2-4 sentence) anecdote/quote for our #MedStoryMonday series!
We will be in touch to request a photo!
Do we have your permission to use your story publicly?
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:
Would you like an invitation to an upcoming PNHP-NY Metro training in storytelling for advocacy ?
Clear selection
Please feel free to submit additional stories via this form at any time.
Thank you! Click "submit" below to finalize.
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy