NC Healthcare Story Form

Are you uninsured or having trouble paying for medical care? Are you dealing with medical debt? Have you experienced racial bias while seeking medical treatment? Have you lost insurance because of a job loss due to COVID-19? If you have been impacted by a lack of insurance, then we’d like to hear from you. Your story* could make a huge difference in helping us fight these healthcare injustices in North Carolina.

* Compensation is possible after an initial story interview.

Please scroll down below the videos to fill out the form.

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Sample Story: Deanna
Hear from Deanna for an example of how we could use your story as part of our advocacy efforts.
Sample Story: Anonymous
If you want to remain anonymous, we'd still love to hear from you. View this example to see how we can amplify your story while protecting your identity.
First Name *
Last Name
Phone number
Email *
County you live in *
Your Story
How long have you been uninsured? How do you access the health care you need? What care are you UNABLE to access?
Do you have health issues or concerns? How does the lack of health insurance impact your life?
If you could communicate with NC legislators about expanding health coverage, what would you tell them?
Complete the following sentence: If I had health coverage I could...
Impact of COVID-19
How has COVID-19 impacted your health insurance coverage?
How has COVID-19 impacted your health, your life and your community?
Racial bias in healthcare
Increasing reports of the staggering toll that COVID-19 is taking on communities of color have been alarming and has put a spotlight on the racial inequities in our health care system. Have you experienced racial bias while seeking medical care either during this pandemic or before? Please tell us your story.
Options for sharing your story
There are many different ways to amplify your story. Please choose the one you are most comfortable with.
Your story can be used in our materials, presentations, discussions with decision-makers and the media, or you can choose to tell your own story, and we could offer different types of support. Your stories will only be used with your permission. Please choose one of the options below. *
May we follow up with you if we have questions?
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