Have you or a loved one been refused reentry to a nursing home or long-term care residence after being hospitalized during the COVID-19 pandemic? Fill out this form to tell us your experiences, and an NPR producer or reporter may call you for an interview to air on the radio.

Your submission will be governed by our general Terms of Use andPrivacy Policy. As the Privacy Policy says, we want you to be aware that there may be circumstances in which the exemptions provided under law for journalistic activities or freedom of expression may override privacy rights you might otherwise have. We will not use your submission in our story until we have communicated with you and obtained your consent to use the details that will be published.

Copyright 2021 NPR. To see more, visit https://www.npr.org.