We Want to Hear From You! Are you a Medicaid recipient in North Carolina?* Yes No What is your date of birth?* MM slash DD slash YYYY Do you have children who are also recipients of Medicaid?* Yes No As a Medicaid recipient, have you struggled to find doctors/health care professionals that accept your medical insurance?* Yes No Approximately how long does it take you see a doctor from the time you make the appointment to the time you're seen in the office?* Any other comments or concerns you would like to share:Name* First Last Phone*Email* At Civitas, we are interested in learning more about your story. Can we contact you to learn more about your experience?* Yes No EmailThis field is for validation purposes and should be left unchanged.
