Start by checking one or both of the boxes below to indicate how you would like to share.
We love to hear how our rapid recovery treatment has positively impacted the lives of our patients. Submit a testimonial and your story could be featured on our blog and/or social media channels.
Our providers love to share photos of their happy patients on their office walls. Choose this option to grant your provider permission to display your photo on his or her patient photo wall.
Then fill out and submit the form below. (fields marked are required to submit)
Attach a photo of you doing an activity you love doing.(Photo must be under 4MB)
When you click Submit you will be asked to read and accept an "Authorization for Use or Disclosure of Health Information" form. You must be at least 18 years of age to accept the terms of this document electronically. If you are under the age of 18, please contact email@example.com to obtain the appropriate form. A copy of the electronically signed agreement will be sent to the email address you provide above; please retain this copy for your records.
For questions or concerns please call (800) 404-6050