Share Your Story

Share your personal story about the urgency of health care reform in your life and the lives of those you love. Be Personal: This is your story, and you should focus on your own life experience, your beliefs, and the changes you hope to see. Be Specific: The most powerful and memorable stories include specific, real-life examples. Be Concise: There's no specific limit on the length of your story, but you should try to communicate the essence of your story as clearly and concisely as possible.

First Name:*

Last Name:*

E-mail Address:*

Zip Code(5-Digit):*

Your health care story: *

Which of the following is your story about?

How health care costs are too high

How you or someone you know has insufficient choice of health care providers

How you or someone you know lacks quality, affordable care

Are you a health care professional?

Select OneI do not work in health careDoctorNurseMedical StudentOther Health Care Professional

*By answering this survey, you are subscribing to my newsletter. By submitting your story, you agree that the story, along with any pictures or video you submit along with the story, is non-confidential and may be freely used and disclosed, in whole or in part and in any manner or media, by or on behalf of the Office of Rep. Heinrich.