TELL US YOUR STORY!

Currently seeking stories on how you or your loved one is using the recent personal needs allowance increase, your experience with short staffing, or what you think North Carolinians need to know about long term care!

if sharing your story through verbal conversation is more comfortable, Please fill out the second form found below to receive a phone call from a forltc member.

Name

Your Email

Zip Code

What is your relationship to resident in long-term care?

Choose long-term facility type

Share Your Personal Story

TELL US YOUR STORY BY PHONE CALL

Name

First Name

Last Name

Phone Number

Please enter below your 10 digit phone number (including area code).

(###)

###

####

What Day May We Contact You?

Please select the day of the week you are available to receive a phone call from a member of FORLTC.

What Time May We Contact You?

Please select a time during business hours that works best for you to be contacted by a member of FORLTC.

Additional comments

If you have additional comments or concerns, please let us know.

TELL US YOUR STORY!

if sharing your story through verbal conversation is more comfortable, Please fill out the second form found below to receive a phone call from a forltc member.

TELL US YOUR STORY BY PHONE CALL

Get News & Alerts!