Share Your Story

Tell us your experience (maximum: 1000 characters)*

Kaiser Medical Center or Clinic where you received care*

Which state do you live in?*

Which city do you live in?*

First name*

Last name*

We will not use your last name or make your last name public without your express permission.

Email*

Phone number where we can reach you*

Age

18-29
30-44
45-64
65+

How do you get your Kaiser insurance? (Check one)*

Public employee health fund
Other employer or union health plan
Medicare
Medi-Cal
Covered California (California's health insurance exchange)

If you are a union member, please tell us which union:

NUHW has my permission to use and/or publish my story.*

Yes
No

We will not use your last name or any other identifying information without your permission.

NUHW is not a healthcare provider and cannot provide any medical services or counseling. If you report your are currently experiencing suicidal ideation, suicide attempts, self-harm, or interpersonal violence/domestic abuse, we can share your story with Kaiser Permanente with a request that they follow up with you to address these urgent issues. Does NUHW have your permission to share your story and contact information with Kaiser Permanente in such a case?

Yes
No

I want to take action! I am willing to:

Talk to a journalist on the record (using my name)
Write or speak to my representative
Join other patients in meeting with Kaiser officials
Take part in a demonstration

Upload File

If you'd like to share your photo or a video message with us, upload the file here (maximum file size: 10MB).

Accepted file types: jpg, gif, png, pdf, mp3, mp4, mpeg, Max. file size: 10 MB.

Kaiser, Don't Deny

Patients need access to timely and consistent mental health services