Responders Story Submission Please give us contact information so we can clarify any questions about your event. When edited and posted - WE WILL NOT USE NAMES OR LOCATIONS in the final write up. It will be a generic accounting of the events. If you would prefer a direct discussion leave an email at [email protected] and Joseph or one of our committee members will be in touch. All information is shared in confidence. Thank you for sharing your experience with others.Name(Required) First Last Email(Required) Phone(Required)Please do not include any HIPAA RELATED or PERSONAL Information below. Tell us WHAT happened?(Required)Were you injured? Was a weapon used? Was the attacker altered?Tell us WHEN it happened?(Required)General date and time of dayTell us WHERE it happened?(Required)Location (County or Region) Patients residence, public area etc.Did law enforcement get involved?(Required) Yes No Other Now that this is over - What if any lessons did you learn?(Required)Was assistance made available to you to debrief or council AFTER THE EVENT? Yes No Declined Other Anything you want to add?WILL NOT BE POSTED IN THE STORY NameThis field is for validation purposes and should be left unchanged.
