Testimonial Permission & Certification Form
CELEBRATING 120 Years
Partnering for a Healthy Community
Thanks for helping us celebrate by sharing your positive stories about ECMC.
Questions/concerns/oral or emailed presentation of story can be provided to Beth Vallier,
or 785-472-3111 ext. 328.
I certify that my testimonial is given freely, without compensation or pressure of any kind. By signing this Testimonial Permission and Certification form, I give permission to Ellsworth County Medical Center to use this testimonial in advertisements, marketing material, or promotional literature, with the following exceptions:
Approximate Month / Year of experience
Person providing the testimonial: