Exit this survey Share Your Story about a Vaccine-Preventable Disease Everyone has a story to tell. Together, we can provide a valuable lesson and share advice with others.Our goal is to share your first-hand knowledge and experience with others throughout New England to help them avoid a similar fate. Your story will send a powerful message about the importance of vaccination. We will share these stories on our website, in our newsletters, educational events or other related opportunities. Learn more on the New England QIN-QIO website: http://www.healthcarefornewengland.org/initiatives/immu/ Question Title Question Title * 1. What was your experience? Please be as detailed as possible. Question Title * 2. When did this happen? Question Title * 3. If you could give any advice, what would it be? Question Title * 4. Your Contact Information: Please note, we do not share or sell any of your contact information Your Name Your Phone Number Press the Blue ‘SUBMIT’ Button below to send us your story electronically. Can I mail or fax my story to you instead?Please print a copy of this page from your internet web browser and send to the following location:By Mail:Healthcentric AdvisorsAttn: Russell Cooney235 Promenade StreetSuite 500, Box 18Providence, RI 02908-OR-By Fax:401-528-3237Attn: Russell Cooney Submit