Share your health care experience with us!

Health reform is at a do-or-die point in the Senate. The more real-life health care experiences our leaders in Washington hear about, the more pressure there is for them to fix what's wrong.

Have you been confused by a recent sudden increase in your premiums? Or have you struggled for a long time with high health care costs or inadequate coverage?

Your story helps us tell Congress what's really happening with Americans' health care. The more we know, the more effective we can be! Please provide your contact information (which we will not share with anyone) so we can learn more details about your experience, if needed.

My experience is primarily about (we understand your story may be about several topics, but we ask that you pick a main category):
A doctor or doctors
My insurance coverage
A hospital
A hospice or nursing home
My employer
A drug or supplement

Tell your story here.

*Would you be willing to give us your permission to publish your comments on our Web site (we will not publish without contacting you again to confirm your permission).

Please provide your phone number and email address so we can communicate with you and learn more about your experience.

* First: * Last:

* Email:

* Street 1:

* City * State * ZIP:

Phone Number:

Yes, I would like to receive free periodic consumer updates from Consumers Union Advocacy. (Sí, me gustaría recibir boletines con información del consumidor de Consumers Union.)
Email Format:

This is not a scientific survey.

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