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)
Please do not include any HIPAA RELATED or PERSONAL Information below.
Were you injured? Was a weapon used? Was the attacker altered?
General date and time of day
Location (County or Region) Patients residence, public area etc.
Did law enforcement get involved?(Required)

Was assistance made available to you to debrief or council AFTER THE EVENT?

WILL NOT BE POSTED IN THE STORY
This field is for validation purposes and should be left unchanged.