Standard of Care
Home
about
get involved
focus groups
volunteers
share your story
social media feature
FAQ
Film Interview Request
If you are interested in sharing your story on camera in the series, please fill out the form below and then follow the prompt to schedule a meeting with Nancy, our director. Please note that you must be
fully vaccinated
in order to participate.*
*
If you are not able to be vaccinated
due to a medical condition
, you must be willing to
get COVID tested and quarantine before your filming date.
*
Indicates required field
Name
*
First
Last
pronouns
*
*
I'd prefer to stay anonymous.
We will offer ways to shield your face and disguise your voice if you'd like to remain anonymous!
Email
*
City
*
State/Province
*
Country
*
What is your experience with medical bias?
*
I would like to speak about...
*
gender identity
race
neurodiversity
weight
location
income
education
incarceration
mental health
addiction
immigration status
other
if other, please specify:
*
By submitting this form, you confirm that you have read and agree to the
model release form
.
Submit
Home
about
get involved
focus groups
volunteers
share your story
social media feature
FAQ