COVID-19: Share Your Story

You may have lost someone you loved or know someone who has suffered or died from the COVID-19 pandemic. Now, more than ever, we need stories to understand the issues and experiences facing our healthcare community today. The Patient Safety Movement Foundation is currently seeking patient and healthcare worker stories around COVID-19. Your story will become an integral part of the narrative driving the Patient Safety Movement forward.

Step 1 of 2

Details about the Story
Name of the person featured in this story
First Last
Is this person still alive?*
- Yes
- No
When did this event take place?*
Month
Day
Year

This may be the date that the event occurred in the hospital or the date a loved one passed away.
Where did this event take place?*
City State / Province / Region Country
Tell us the story*
You have 3,500 characters (or about two pages of text) to tell your story. If you need more space please email [email protected]
Upload an Image
Accepted file types: jpg, png, Max. file size: 1 MB.
Please upload an image of the person who is represented in the story. Provide us with the highest resolution image as possible, and please upload a color photo.
Upload a Video
Accepted file types: mov, mp4, Max. file size: 100 MB.
This video you share, if shared before August 20th, may be woven into the programming of the #uniteforsafecare virtual event which will be aired on September 17th and then live in perpetuity on YouTube.

Your Information
Name*
First Last
Email*
Phone Number
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Organization You Represent (if applicable)

If you are affiliated with an organization that relates to this story, please share that with us.
Organization's Website

If applicable, please indicate whether this event launched an organization or group that you'd like to share with us.
Acknowledgement*
I hereby authorize The Patient Safety Movement Foundation (PSMF) and assign the rights to display, publicly perform, exhibit, transmit, broadcast, reproduce, record, photograph, digitize, modify, alter, edit, adapt, create derivative works, otherwise use, and permit others to use, the name, logo(s), publicly available data and images of the person listed above and its relevant affiliates on any platform and for any purpose including, but not limited to, advertising, public relations, publicity, packaging, and promotion of the PSMF without further consent or consideration from the person listed above.
CAPTCHA

COVID-19: Share Your Story

Step 1 of 2

Details about the Story

Your Information