Share Your Story

 Submit your Vincera story. The required fields are marked with an asterisk (*).
Name*
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Email*
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Age
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Location (Country)
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Location (City)
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Location (State)
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Athlete Description
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(Track and Field, Football, Baseball, etc.)

Patient Background
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Diagnosis & Treatment
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Recovery Story
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(Please use this space to describe the impact that the procedure had on your life)

Testimonial*
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Whereas VINCERA INSTITUTE represents all entities that are affiliated with Vincera Institute the facility, including Vincera Rehab, LLC, Nava Yoga Center, Inc., and Vincera Core Physicians.

By submitting my information, I do hereby give VINCERA INSTITUTE, its employees or agents the right to use a testimonial statement or story representing my care with VINCERA INSTITUTE for reproduction in any medium including but not limited to web and print for purposes of advertising or editorial use. I warrant that no other party’s consent is required. I release VINCERA INSTITUTE from all claims for libel, slander, invasion of privacy, infringement of copyright or right of publicity or any other claim. I am an adult and fully authorized to sign this Consent and Release.

I further consent that my name and identity may be revealed therein or by descriptive text or commentary, and I may no longer be protected by the federal HIPAA Privacy Rule. I waive any rights, claims, or interest I may have to control the use of my identity or likeness in whatever media used.

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