To optionally supplement this "Contact Form", please contribute your thoughts, experiences, concerns and stories related to the "human dimension of healthcare", particulary how it relates to social justice, racial disparities and bias. You may enter anonymously or identified by your email address. Please note that if you would like a response, you must enter your valid email address. Your email address will not be made public. Email (optional): Location: Rate your healthcare experience as humanistic: 1 (low) 2 3 4 5(high) Provider Source of your Healthcare Experience: Select Provider Source Primary Care Physcian Primary Care Nurse Practitioner Primary Care Physician Assistant Referral Provider/Consultant Hospital Emergency Department Urgent Care Center _______________________________ I am a provider Other Comments and / or inquiries To confirm you are not a robot, enter the following code in the text field:
Email (optional): Location: Rate your healthcare experience as humanistic: 1 (low) 2 3 4 5(high) Provider Source of your Healthcare Experience: Select Provider Source Primary Care Physcian Primary Care Nurse Practitioner Primary Care Physician Assistant Referral Provider/Consultant Hospital Emergency Department Urgent Care Center _______________________________ I am a provider Other Comments and / or inquiries To confirm you are not a robot, enter the following code in the text field:
