RESOLVE's Washington State Family Building Survey

Share your family building story so we can educate lawmakers about the need for infertility insurance coverage in Washington State. Please complete the survey below and let us know if you would like to stay informed or become engaged in these advocacy efforts.

RESOLVE: The National Infertility Association is working with a dedicated group of patients and professionals in Washington State and we welcome your involvement!

Please note your information will be kept confidential and only used with your permission.

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* 1. Contact Information:

First and Last Name *

Address *

Address 2

City/Town *

ZIP/Postal Code *

Email Address *

Phone Number *

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* 2. Where are you in your family building journey? Please share whatever you are comfortable sharing.

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* 3. Was/is cost an issue getting the medical treatment you need? Please share whether, at the time of seeking fertility treatments, you had insurance coverage or paid out of pocket?

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* 4. Were/are you a cancer patient or undergoing medical treatment that may cause infertility and need(ed) to preserve your fertility before starting chemotherapy or another medical treatment?

Yes

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* 5. Do you have any connections to people in the state legislature or Governor's office?

If yes, please specify:

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* 6. Do you have any connections to or memberships in organizations that could be supportive, including but not limited to women's health, cancer, LGBTQ+ issues, and/or the BIPOC (Black, Indigenous and People of Color) community?

If yes, please specify:

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* 7. Please indicate your willingness to participate in any of the following: (Check all that apply)

Call and send letters to my elected officials

Meet with my elected officials (virtually or in person when it's safe)

Share my story with the media

Engage in social media to educate the public

Talk to my employer about adding coverage

Other (please specify)