Share Your Story: Epilepsy & Medicaid
The Epilepsy Foundation is committed to involving people with epilepsy and their families and caregivers in the policymaking process. As Congress debates health care reform and radical changes to the Medicaid program, we are collecting the stories of people with epilepsy who rely on Medicaid. Share your story with us by filling out the form below.
First Name
Your answer
Last Name
Your answer
State
Your answer
Email address
Your answer
Phone number
Your answer
How old are you (or your child?)
Your answer
What kind of health insurance do you (or your child) have? Check all that apply
Required
How did you (or your child) qualify for Medicaid? Check all that apply
Required
How long have you (or your child) been enrolled in Medicaid?
Your answer
What role does Medicaid play in helping you access medical care?
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms