Share Your Testimony!
Thank you for sharing your chiropractic story! By sharing your story, you are impacting many people and showing them that there is HOPE through principled chiropractic! For valuable consideration, I hereby irrevocably consent to and authorize the use and reproduction by Third Coast Chiropractic LLC., or anyone authorized by Third Coast Chiropractic LLC., of any and all photographs/videos/Success stories which you have this day taken of
for the purposed of promotional TV, website, social media and/or print ad whatsoever, without further compensation to me. All negatives and positives, together with the prints shall constitute the property of Third Coast Chiropractic LLC., solely and completely. Any information voluntarily provided by a patient shall also be used in conjunction with the above-listed information for purposes previously mentioned. Confidentially, in regards to any reported conditions, is also waived to the extent of information pertinent to the promotion material only. I authorize Third Coast Chiropractic LLC. to share this information via their website and their Facebook/social media including Twitter and Instagram, and for use in the office. All other unrelated patient information shall remain private and protected (according to Health Information and Privacy Act laws).