Report A Medical Event

medical_surveyThe goal of this joint effort by Empowered Patient Coalition and Consumers Union Safe Patient Project is to capture a snapshot of the impact of medical events from the patient’s point of view.

This survey is designed to answer questions that are important to patients. We want the public to know that they can and must be the cornerstone to improving health care quality and safety and that their experiences are being counted.

The survey is divided into sections covering various categories of medical adverse events.  Boxes simply can be checked but we encourage you to use the narrative sections to share vital details, observations and suggestions.

Your contact information will remain completely confidential unless you give us permission to use or share it. With the understanding that this is a voluntary survey containing subjective data, we make our findings available to the public through this website.

Sharing your story will ensure that your experiences will assist us in collecting data to be used to identify the sources of medical harm and to look for ways to keep patients safe in the future by reporting our findings in research papers and media articles. Please follow the following link to take the survey and thank you for your time.

Fill Out An Adverse Event Survey Here