If you have a patient story from one of our member charities, please submit it using the form below. You may also include pictures by e-mailing digital copies of them to chcmi@aol.com.


                                                 Your Name:  

                                    Your Phone Number: 

                              Featured Person's Name:

                Featured Person's Phone Number:

                           Guardian's Name & Phone
                                    if person is under 18: 

                         Agency represented in story:

    Please type your story below. We will always contact you before publishing it.
                                                                      

                     Will you be adding a picture? Yes     No

          Does CHCMI have permission to use
          the story in all marketing materials?  Yes      No     

         If No, Please specify allowable uses: 

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