Share Your Message of Gratitude

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Henry Ford Health System may decide to use your story for public relations or marketing activities. By submitting this form, you grant Henry Ford Health permission to use your testimonial in the following ways: • Henry Ford website and/or social media sites • Henry Ford marketing and/or advertising • Henry Ford internal and external publications • Henry Ford patient and/or medical education • News media You also understand that you will not be financially compensated by Henry Ford Health. Upon completion, this form will be submitted to the Henry Ford Information Privacy & Security Office. You have the right to revoke this authorization at any time by emailing PrivacySecurity@hfhs.org.