If you have already been using comprehensive integrative care, or even a portion of it—diet, exercise, sleep, stress management, healing your gut, environmental detoxification, supplementation or appropriately used medication — please feel free to write your positive experiences to inspire and motivate others. Please be aware that once reviewed and approved, your testimonial will be public, for everyone to read.
Prior to submitting your testimonial, please review the short release statement below the form.
Submit a Testimonial
Welcome to the LCDA
As a naturopathic physician who has used The Eight Essentials for nearly 30 years in treating patients with all types of diabetes, I am delighted to be part of this non-profit, educating others how to be successful in preventing and successfully treating diabetic patients through their application.
Patient Testimonial Release Consent
Purpose of Consent: By completing the above form, you are consenting to the Low Carb Diabetes Association (LCDA) using and disclosing the information in your testimonial, acknowledging that the testimonial will be distributed to the public.
Right to Revoke: You have the right to revoke this Release at any time by giving us written notice of your revocation and submitting it to firstname.lastname@example.org. Please understand that revocation of this Release will not affect any action the LCDA took in reliance on this Release before receiving your revocation.
CONSENT TO RELEASE
I hereby authorize the LCDA to use my testimonial and any information in the testimonial in its public relations efforts. I understand and approve the disclosure by the LCDA of testimonial information to the media and other individuals and entities that may be involved in the LCDA’s public relations efforts.
I understand that I am providing the testimonial information to the LCDA and that my treating physician will not be providing any information to the LCDA, including private health information in my medical records, the confidentiality of which is protected by federal and state statutes and regulations, including, Health Insurance Portability and Accountability Act (HIPAA).
I waive the right of prior approval and hereby release the LCDA from all claims for damages of any kind based on the use of my testimonial or information in the testimonial.
I am of legal age and freely sign this release, which I have read and understood. The below information will not show up on the testimonial page.