Left Behind: Ambulance Emergency Services

First Name

Last Name

Have you ever been transported by ambulance/EMS and forced to leave your adaptive equipment behind?

Yes

No

NA

Describe what happened:

Can we contact you to talk to you about your experience?

Yes

No

Are you interested in joining Access Living’s campaign on adaptive equipment and EMS?

Yes

No

What is your preferred method of communication?

Please list the email address or phone/tty number we should use to contact you:

reCAPTCHA

Tell Us Your Story: EMS/Adaptive Equipment