Chellie Pingree for Congress:

How does the healthcare crisis affect you?

Email: *

First Name: *

Last Name: *

Address:

City:

State:

Zip/ Postal Code: *

Phone:

When it comes to health insurance, are you:
  Uninsured
  Under-insured
  Adequately insured

2. If you have health insurance today, have you or any members of your family ever been uninsured:
Yes
No

3. If you are uninsured or underinsured, what would you say is the biggest barrier to your getting adequate health insurance:

Additional comments:

* denotes required field

Thanks for participating!

P.O. Box 17613
Portland, Maine 04112

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