Medical Abuse Hotline Planning Survey

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

To honor Carrie Ann Lucas's life and work, and mobilize a powerful national response to her unjust death, we're teaming up with disability justice communities & progressive health workers from around the US -- including leaders like Carrie Ann's partner, Dr. Kimberley Jackson, the Do No Harm Coalition, and Sins Invalid, to launch a Medical Abuse Hotline! Learn more about Carrie Ann and our campaign here: https://www.healthjusticecommons.org/campaign.

Join us for an online Town Hall Gathering on AUGUST 4th, at NOON PT via Zoom. Live Captioning will be provided! Learn more and RSVP at: https://www.healthjusticecommons.org/upcoming-events

To ensure this herstoric hotline's success, that it meets and is accountable to community need, and catalyzes as much healing and transformation as possible, we're inviting you to provide your valuable planning input. This survey is also a tool to help us build the hotline's referral network.

Deepest thanks for your time and input!

Email *

Name and organizational affiliation if any

What types of support and services would you like the Medical Abuse Hotline to offer?

Compassionate listening

Peer counseling

Crisis intervention

Referrals to diverse types of health workers vetted for competency in intersectional social justice

Collaborative problem solving/ advocacy coaching

Human rights violation documentation

Medical ethics or HIPPA violation documentation

Collecting data for potential class action lawsuits (for those consenting to participate)

Other:

What resources would you like our referral network to include?

Therapists and other mental health workers

Psychiatrists

Medical doctors

Medical specialists

Nurses

Medical and nursing students

Research scientists who research common diseases

Medical residents

Naturopaths

Curanderas/x

Energy workers

Chiropractors

Attorneys who specialize in medical abuse, medical malpractice or medical class actions

Traditional Chinese Medicine doctors/ accupuncturists

Ayurvedic doctors

Body workers and massage therapists

Trauma specialists

Somatic practitioners

Yoga and movement teachers

Physical therapists

Cranial Sacral therapists

Medical intuitives

Other:

Would you and/or your organization like to join our referral network? If yes, we will follow-up with you with additional information regarding expectations for participation and our network participation criteria.

Yes

Maybe, please contact me so I or my organization can learn more

Other:

Clear selection

Are there practitioners or organizations you would like to recommend for the referral network? If so, please provide their names and contact information below. Or, feel free to forward this survey to them so they can complete it and/or contact us.

Would you like to volunteer as a hotline call responder? Training will be available with other amazing responders!

Yes

Not sure, but I'd like more info on getting involved

Other:

Clear selection

Do you have a survival story of medical abuse or mistreatment you'd like to share? If it feels safe, please feel free to share it here. All information will remain confidential and no part of your story will be used without your permission. If you have a story to share, but would prefer to contact us for a one-on-one confidential phone call or video chat conversation, please let us know. We'll reach out to schedule.

Do you have anything else you'd like to add? Please share it here, your feedback and insights are deeply appreciated.

Would you like to be added to our email list for announcements, upcoming events and resources? We send about one email per 4-6 weeks.

Yes

Please add my family member, partner, friend, organization:

Other:

Clear selection

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