My Chiropractic Success Story

Do you have an exciting chiropractic success story to share? We’d love to hear about your experience and possibly use it on our website or other marketing materials. Please share your detailed story by completing the questions below.
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Please note: Information collected is for Chiro One Wellness Centers’ marketing purposes only and will not be shared with any other party or used for any other purpose.

Terms of Use and Agreement

I hereby consent to the Chiro One Wellness Center entities, TVG-Medulla, LLC (its marketing services provider),  and their affiliated companies, doctors, and employees (collectively “Chiro One”)  recording, videotaping, audiotaping, photographing, editing, modifying, copying, or otherwise reproducing “My Chiropractic Success Story.”

I grant to Chiro One the right to use my voice, likeness, first name and last name initial, and the content of “My Chiropractic Success Story,” as edited by Chiro One in its sole discretion, in connection with promoting Chiro One’s chiropractic care and other marketing purposes, and I release any expectation of privacy or confidentiality of “My Chiropractic Success Story” and any expectation of ownership or compensation from Chiro One.

I further grant to Chiro One and its assignees and licensees a perpetual, royalty-free, worldwide license for the limited purposes above in any medium, including, without limitation, print, television (including broadcast, cable, and satellite), electronic (including the internet and intranet), and any other communications media currently existing or later created.

I represent that:

  1. I am over the age of 18 years;
  2. I have authority to grant consent as provided herein on behalf of myself, my heirs, representative, and assigns; and
  3. my “Chiropractic Success Story” submitted to Chiro One was true.

By submitting this form you agree to the above "Terms of Use and Agreement."*

Have a minute or two? We'd love it if you'd share your experience online. Please search for your Chiro One office on Yelp and leave us a review.

If you experience issues submitting this form, please contact us at websupport@chiroone.net.