West Parry Sound Health Centre Foundation : Share Your Story

Grateful Patient Stories
Submission

First Name *

Last Name *

Email Address *

Phone Number *

Please share your grateful patient story or message of gratitude. *

If you know the specific department or individual who inspired you to share your story, please include their name(s)

Upload your photo *

Can West Parry Sound Health Centre Foundation reach out to you about publishing your story? *

Yes, West Parry Sound Health Centre Foundation may follow up for additional information and permission to publish my story
No, I do not wish to be contacted about my story

By submitting this form, I give West Parry Sound Health Centre Foundation permission to collect and use the information, story, photographs, video and/or other content I provide for Foundation communications, storytelling, fundraising, marketing and promotional purposes.

I understand that my story and submitted content may be edited for length or clarity and may be shared through WPSHCF websites, social media, email, print materials, media, advertising and other public communications.

I understand that once information or content has been published or shared publicly, WPSHCF may not be able to control how it is subsequently shared by others.

I may withdraw my consent for future use at any time by contacting foundation@wpshc.com. Withdrawal will apply to future use and may not affect materials that have already been published, printed or distributed. PIPEDA recognizes that individuals may withdraw consent, subject to applicable restrictions and reasonable notice.

Consent to Share Your Story *

I have read and understand the consent information above and give West Parry Sound Health Centre Foundation permission to collect, use and share my submitted story, photo and other content as described.