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Has your family experienced a medical error? Tell us about it.

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Vox and ProPublica would like to hear from patients who have been harmed while undergoing medical care.

If you or a loved one has suffered patient harm, you can help inform our reporting by filling out the form below. It asks quite a few questions, but please don't be intimidated. Just do your best to summarize your story.

With your permission, a reporter may follow up if we have additional questions. The information you submit on this form is being submitted to and stored with ProPublica, who is sharing the information with us, and is subject to the ProPublica Privacy Policy. We will keep your information confidential unless you give us permission to share it.

For more on medical errors, read "Medical errors in America kill more people than AIDS or drug overdoses. Here's why."