12 Goffle Road, Midland Park, NJ 07432 phone 201-447-2570  follow us

SHARE Your Story

We are honored that you are a Nuzzi Chiropractic Lifestyle Wellness Center patient. You have seen first hand how effective therapy can be. Help us share your story with others. Has chiropractic relieved your pain and given you back the ability to enjoy life? Has it helped you avoid surgery? Has it changed your world and improved your life? Whatever your testimonial, don't keep it to yourself.

 

Please fill out this short questionnaire. When you are finished, please read the release at the bottom of the page which gives us permission to share your testimonial. Your testimonial could help improve the lives of others by showing how care at Nuzzi Chiropractic Lifestyle Wellness Center has positively impacted your life.

Patient Testimonial Release Consent

Purpose of Consent: By clicking 'Submit', you are consenting to Nuzzi Chiropractic Lifestyle Wellness Center's use and disclosure of the information in your testimonial and acknowledgment that the testimonial may be distributed to the public.

 

Right to Revoke: You have the right to revoke this Release at any time by giving us notice, in writing or email, of your revocation and submitting it to Nuzzi Chiropractic Lifestyle Wellness Center. Please understand that revocation of this Release will not affect any action Nuzzi Chiropractic Lifestyle Wellness Center took in reliance on this Release before receiving your revocation.

 

CONSENT TO RELEASE

By clicking the 'Submit' button on this page, I hereby authorize Nuzzi Chiropractic Lifestyle Wellness Center to use my testimonial and any information in the testimonial in its public relations efforts. I understand and approve the disclosure by Nuzzi Chiropractic Lifestyle Wellness Center of testimonial information to the media and other individuals and entities that may be involved in Nuzzi Chiropractic Lifestyle Wellness Center public relations efforts.

 

I understand that I am providing the testimonial information to Nuzzi Chiropractic Lifestyle Wellness Center and that my treating physician will not be providing any information to Nuzzi Chiropractic Lifestyle Wellness Center, including private health information in my medical records, the confidentiality of which may be 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 Nuzzi Chiropractic Lifestyle Wellness Center 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 Submit this release, which I have read and understood.

Office Hours

Monday: 9:00 to 1:00 pm; 3:00 to 7:30 pm

Tuesday: 9:00 to 1:00 pm

Wednesday: 9:00 to 1:00 pm; 3:00 to 7:00 pm

Thursday: 3:30 to 7:30 pm

Friday: 9:00 to 1:00 pm; 3:00 to 7:00 pm

12 Goffle rd, Midland park, nj 07432

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LIFESTYLE

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phone 201-447-2570

fax 201-447-4206

Copyright 2016 NUZZI CHIROPRACTIC Family & Sports Center, LLC. in Midland Park New Jersey All Rights Reserved