My Wellness Journey

Please help Southeast Health Group inspire others by sharing your wellness journey with the public.  Your story may appear on our website, or in written materials or presentations, to show that progress is possible. Tell us if you would like to use your real name, or remain anonymous.  Thank you for helping us to inspire others!

 

By entering your information, typing your name on the signature line, and clicking submit, you are agreeing to allow SHG to share your journey. 

 

I,

grant permission to Southeast Health Group to use direct quotes of statements I have made.  These statements will be used for educational purposes and can be published in any form of media.  I understand that my personal and medical information is protected under HIPAA and Southeast Health Group will not disclose this information.  Also, I understand that my identity will not be disclosed. 

 

By electronically signing below, I am voluntarily participating in sharing my journey. I understand that I have a right to revoke my permission at any time by contacting Southeast Health Group and completing a Revocation Form. Revoking this permission will not affect my services.