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Please sign the Testimonial Media Release & Consent Form, which gives us permission to use your comments for promotional purposes.

I agree that Northern Edge Physical Therapy, LLC can use my “testimonial” on their website or other marketing materials and public relations activities to promote their practice. I approve the content (and images, if applicable) of my testimonial and hereby release Northern Edge Physical Therapy, LLC from any damages based on my testimonial. I also authorize Northern Edge Physical Therapy, LLC to use my name, brief biographical information, and the testimonial as defined on this form. I hereby give my permission for Northern Edge Physical Therapy, LLC to copy, exhibit, publish or distribute the testimonial for purposes of publicizing Northern Edge Physical Therapy, LLC services or for any other lawful purpose. I reviewed this authorization form and hereby give my consent to release my testimonial, as indicated above.