Support Special Needs — Access Beyond Barriers logoSupport Special Needs

Share your experience

Help show decision-makers where access is failing.

Your experience can help identify provider shortages, insurance barriers, long waitlists, and missing accommodations. You control how your submission may be used.

0 experiences shared so far

Why we are collecting this

Your answers become anonymous, organized evidence of the barriers patients with autism and other special needs face in finding medical and dental care. We bring that evidence to Medicaid agencies, insurers, and lawmakers. It takes about ten minutes.

Your privacy

Your complete response will be stored securely and reviewed only by authorized administrators. Public reports will use anonymous, combined statistics. If you choose to answer the optional story questions and provide consent, only your age, state, and written story will be displayed on the website. Your name, contact information, and all other identifying information will remain private, unless you specifically enter personal information in the story section — then it will be displayed as is.

Before you begin

  • The form takes about ten minutes and can be saved and finished later.
  • Please do not include medical records, insurance identification numbers, Social Security numbers, or full dates of birth.
  • Nothing is published without the specific permissions you select.
  • This form is not for emergencies. In an emergency, call 911.

Step 1 of 2

Survey questions

Your progress is saved automatically on this device as you answer.

Your complete response will be stored securely and reviewed only by authorized administrators. Public reports will use anonymous, combined statistics. If you choose to answer the optional story questions and provide consent, only your age, state, and written story will be displayed on the website. Your name, contact information, and all other identifying information will remain private, unless you specifically enter personal information in the story section — then it will be displayed as is.

Patient information

This section is about the patient who needed care.

Age is collected for statistical purposes only. Please do not share a date of birth.

Which of these describe the patient's needs? (required)

Select all that apply. A detailed medical diagnosis is never required.

Insurance coverage (required)

Person completing this form

This section is about the person filling out the form.

Relationship to patient (required)
Preferred contact method (required)

Your name and contact information are never published. They are stored securely and used only by authorized administrators. Please do not include Medicaid or insurance identification numbers, Social Security numbers, or medical records anywhere in this form.

Medical and dental concerns

Please describe your experience without naming any individual, provider, practice, hospital, insurer, or agency. This survey is not intended to criticize or place blame on any organization. Its purpose is to document barriers to medical and dental care and to raise awareness so access can be improved for patients with special needs.

Medical concerns

Select every medical access problem your family experienced.

Dental concerns

Select every dental access problem your family experienced.

Access and timeline

These questions are asked separately for medical care and dental care so the statistics stay clear and organized. You only answer the sections that match the concerns you selected.

Please describe your experience without naming any individual, provider, practice, hospital, insurer, or agency. This survey is not intended to criticize or place blame on any organization. Its purpose is to document barriers to medical and dental care and to raise awareness so access can be improved for patients with special needs.