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Medical Weight Loss Testimonial

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

 

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Are you a patient in Belmond or Des Moines?:
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How would you like your name shared with your testimonial?:
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Would you like to include photos?:
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Accepted Formats: Images
Accepted Formats: Images
Would you be interested in doing a video testimonial?:
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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.

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