Business / Practice name / Practice location
*
Event name / location (city/state)
*
Name of Submitter
*
First & Last Name
Submitter's Email
*
example@example.com
Which social media platforms are we posting on?
*
Facebook
Instagram
Which locations would you like this posted on?
*
Facebook URL
*
Instagram URL
*
LinkedIn URL
*
Nextdoor URL
*
Date content was captured
*
-
Month
-
Day
Year
Date
Requested posting date
*
-
Month
-
Day
Year
Please note 72 business hour turnaround time
Who is in the photo?
*
Provide names, titles, and practice/business name. Provide social media handles if available to tag
Tell us the story of what is happening in this photo (we will use this info to create a caption)
*
Would you like to provide your own caption and hashtags?
*
Upload File
*
Upload a File
You can upload any type of file. Max: 300 MB
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HIPAA Talent Release Form
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