Whole Health Chiropractic Testimonial
Since starting Chiropractic care, how has your health changed?
Your answer
How have you been feeling better?
Your answer
How has your Quality of Life (sports, new activities, able to go back to past enjoyable activities, etc.) changed?
Your answer
Have you noticed a change or improvement with the following areas?
Have you experienced less of a need to take over-the-counter or prescription medications?
What can you do now that you haven’t been able to do in the past?
Your answer
What changes have your family or friends seen in you since you have become healthier?
Your answer
What would you like to say to Dr. Rehmer about your new life?
Your answer
What would you like to share with Dr. Rehmer’s patients regarding Chiropractic care?
Your answer
Is there anything else you would like to share with us regarding your experiences with our office?
Your answer
Authorization and Release of Testimonial
I understand my testimonial as outlined above (the "Testimonial") and made on behalf of Whole Health Chiropractic Wellness Center (hereinafter called "The Practice") may be used in connection with publicizing and promoting The Practice. I authorize The Practice to use my name, brief biographical information, and the Testimonial as defined on this form.

I hereby irrevocably authorize The Practice to copy, exhibit, publish or distribute the Testimonial for purposes of publicizing The Practice’s services or for any other lawful purpose. These statements may be used in printed publications, multimedia presentations, on websites or in any other distribution media. I agree that I will make no monetary or other claim against The Practice for the use of the statement.

In addition, I waive any right to inspect or approve the finished product, including written copy, wherein my testimonial appears.

I hereby hold harmless and release The Practice from all claims, demands and causes of action which I, my heirs, representatives, executors, administrators or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

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