Have COVID restrictions kept you from visiting a loved one at a health care facility?
Health News Florida is reporting on staffing shortages in nursing homes and assisted living facilities. If you or your loved one has been affected in any way over the past year, we'd like to hear your story. And if you're willing, a reporter may contact you for an upcoming series.

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Email *
Full name *
Where do you live? *
Type of facility that restricted visitation for you (Hospital, nursing home, etc.)
How did COVID visitation restrictions affected your family?
When did the incident occur?
Have you since been able to resume regular visitation?
What can health providers and state lawmakers to address the issue?
Can a reporter contact you?
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