The information that you submit to us through this form is secure and will only be viewed by our marketing staff for the purpose of collecting patient stories for this campaign. To participate in this campaign, you must be comfortable being on camera and willing to travel to the Burlington Vermont area for the photo/video shoot. If we feel that your story is a good fit, we will be in touch within two weeks of receiving your form submission and will provide next steps at that time. Qualified applicants must sign a HIPAA authorization form and a photo/video release form before being able to participate. Thank you for your interest!
Or call 1-800-230-7526