We are looking for great stories about our patients that can be used in an upcoming marketing campaign. If you or your child have been a recent patient at EIRMC, your story just might be what we are looking for! We are looking for the big stories (like the life-saving flight via the helicopter) and the small, but still impactful, stories (like the broken leg during cheerleading practice).

To be considered, first complete this form... so we can get to know you better. We are hoping for an avalanche of responses to use on social media. A small number of the entries will be also be selected for use in advertising material (print ads, billboards, etc.) in our region. Those patients must be willing to participate in a photo shoot.

Because of patient privacy laws, only the actual patient or patient's legal representative should complete this form.

Story Submission Form

Required fields are marked with an asterisk *.

Patient Information

Optional: Please upload a photo of the patient doing something they love (or with the people they love!)

Only JPG and PNG type files can be uploaded.

Patient Representative Information

If you're not the patient, please also complete this section.

I certify that the photo is either not copyrighted through a professional photographer or that I have written permission from the professional photographer to share. *
I certify that I am the patient or the legal representative of the patient. *
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