Behavioral Health Testimonials

Please submit your Behavioral Health story here. If you would like to share a Surgical Weight Loss or Medical Weight Loss story, please visit those pages.

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Name:

Date of Surgery or Date of First Visit:

Please describe how participating in our mental health services has affected your weight loss journey.:

Please describe your experience with our mental health services. :

How would you like your name shared with your testimonial?:

First and Last Name

First Name Only

Initials Only

Remain Anonymous

Would you like to include photos?:

Yes

Upload Before Photo:

Accepted Formats: Images

Upload After Photo:

Accepted Formats: Images

By electronically signing this form, I grant Iowa Weight Loss Specialists and Iowa Specialty Hospital and their employee’s permission to use my photo, filmed image and/or personal testimonial taken on the date indicated below for publicity, educational purposes, website and/or social media (including, but not limited to, Facebook, Twitter and YouTube).

I understand that I will not be paid or receive any reimbursement for the use of my photo, filmed image and /or testimonial. I further give Iowa Weight Loss Specialists and Iowa Specialty Hospital and their employee’s permission to use my name and/or information that was given in accordance with my photo, filmed image and/or testimonial.

Required Signature:

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Email Address:

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Behavioral Health Testimonials

Des Moines

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