Health is Health Story Collection

Request edit access

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

Have you ever struggled to get health insurance to cover mental health or substance use treatment for you or someone you know?

The Health is Health Campaign is collecting stories to help make the case for improving access to mental health and addiction treatment in Michigan.

Please take a moment to fill out the information below. Health is Health will not use your story without first contacting you for your written permission.

Michigan is taking big steps to improve mental health access, your story can help us keep moving forward.

First Name *

Last Name *

Email *

Phone *

City *

Zip Code *

How would you like to share your story?

In Writing -- I’d like to write my story in the form below

Over the Phone -- I’d like someone to call me to hear my story

My Story:

This story is about (select all that apply)

My spouse

My minor child (0-18)

My parent

My sibling

Other.. (specify)

I am a:

Provider

Patient

Parent

Family Member

Other.. (Specify)

Thank you for sharing your story. Is there anything else you'd like us to know?

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of inseparable.us. Report Abuse

Forms