Share Your Story

Sharing your story is an important step that you can take to impact real change in our state! Your story allows us to track successes and areas in need of improvement in working to ensure access to quality, affordable health care for every Floridian! Your story also connects human experiences to the development of important health laws by making issues more realistic for those who may not have personal health care problems. Please make your voice heard and take a moment to share your health care story with us. We are grateful for your time and willingness to share. If you would like to remain anonymous, please click here.




Are you a health care consumer or an enrollment helper? Please select one.*

 

Please indicate your health coverage status.*

 

Do you have special coverage status? (If applicable.)

 

What is your household size?*

 

What is your annual household income?*

 

Do you want more information about Florida’s Health Insurance Marketplace?*

Yes
No

If you are a health care consumer, please indicate your coverage issue. You may select more than one.*

Medicare
Medicaid
KidCare/Florida Healthy Kids
Uninsured (Lack of Coverage)
Medical Debt
Individual Private Insurance Coverage
Health Insurance Marketplace (Affordable Care Act coverage)
Employer Sponsored Private Insurance
Small Business Owner
Other
Not Applicable

If you are an enrollment helper, please indicate your issue. You may select more than one.*

Share a Successful Enrollment Story
Enrollment Fair Feedback
Health Insurance Marketplace Issue
Not Applicable

Are you sharing a health care success story?

Share a Successful Enrollment Story

Are you sharing this story on behalf of someone else?*

Yes
No

Share your story in the box below.

By submitting your story, you give your permission to Florida CHAIN and its partner organizations to use and publish any part of your story without restriction and without compensation. You also release Florida CHAIN and its agents, employees, and volunteers from liability for any future claim that may arise from the use of your story.

First Name:*

Last Name:*

Email Address:*

Phone Number:*

County:*

 

ZIP Code:

What other ways are you willing to share your story?

Letter to the Editor Submissions
Media Interviews
Legislative Visits
Speaking at Town Hall or Public Event