Stay In-Touch Become A Patient Ambassador!Date MM slash DD slash YYYY Name*NumberEmail Mark opportunities you are comfortable with: Being a referral source for potential patients inquiring about similar procedures Use of before and after photos on website Use of before and after in-office & seminars Speaking about your experience at one of Dr. Thompson's seminars Photoshoot for website homepage with testimonial Online video testimonial for website & social media posts Testimonial and/or pictures in television commercial Television appearances with Dr. Thompson regarding procedure(s)Contact [email protected] with any questions or concerns. ONLINE REVIEWS are INCREDIBLY helpful for those in the research process! Please leave your testimonial at 1 or more of the review sites listed at the page that will appear after hitting the submit button. Enter the number of reviews left at the bottom of the page to be entered in the next contest for FREE BOTOX! Each review is one entry:) Email [email protected] with any questions.Add any criteria or limitations requested regarding this authorization:SignatureΔ
