Leave A Video Testimonial

We always appreciate patient testimonials it tells us and our new friends we are doing a great job.  The best part is it is so simple to do.  

Simply click the Record Video button below
Allow program will access your webcam and microphone automatically just click allow.
Record your video and if you like it just hit Submit.
You can even use your cell phone if you like.

By recording this video, uploading a video or supplying a written testimonial, I understand that I am voluntarily allowing my testimonial, image, name, and other specific information to be used in connection with publicizing and promoting ProActive Chiropractic. I authorize ProActive Chiropractic to use my name, brief biographical information, and the Testimonial as defined above.  I hereby irrevocably authorize ProActive Chiropractic to copy, exhibit, publish or distribute the Testimonial for purposes of publicizing ProActive Chiropractic’s programs or for any other lawful purpose. These statements may be used in printed publications, multimedia presentations, on websites or in any other distribution media. I agree that I will make no monetary or other claim against ProActive Chiropractic for the use of the statement.  In addition, I waive any right to inspect or approve the finished product, including written copy, wherein my likeness or my testimonial appears.  I hereby hold harmless and release ProActive Chiropractic from all claims, demands and causes of action which I, my heirs, representatives, executors, administrators or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.