Share Your Story !

Tell us how short staffing prevents you from practicing at your highest professional
standard.  With your permission, your story will be used in public forums and
reports that seek state-regulated staffing ratios.  No patients name please!

                                                             I grant Permission to use: 
                           Statement Only   Statement & Name    Statment, Name & Facility  

        First Name              

         Last Name      

   Street Address                 

                  City                 State          Zip  

              Phone                   E-mail  

               Facility