CSE Video Submit Form

Share Your Experience

Submit your video to be entered to WIN a gift card!
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Video Guidelines: Please record a clear, well-lit video (horizontal) sharing your experience with Cornerstone Eye Associates. Your video should be no longer than 10 minutes, and you must own the rights to all music, images, and content included. Ensure your video does not contain inappropriate language, images, or sounds. By uploading, you confirm it’s your original video and consent to its use under the Patient Testimonial Agreement.
Patient Testimonial Agreement: By submitting this testimonial, I give Cornerstone Eye Associates permission to use my written comments, name (first name and last initial only), and any photo or video I choose to share for marketing, promotional, and educational purposes. I understand that my testimonial may appear on the practice’s website, social media, printed materials, or other public platforms. I confirm that my statements reflect my personal experience as a patient and that I am voluntarily providing this information. I understand that no compensation will be provided, that the practice may edit or decline my submission, and that I may revoke this consent in writing at any time, though materials already published may continue to be used. Cornerstone Eye Associates will protect my personal health information in accordance with HIPAA and will not disclose details beyond what I choose to include in this testimonial.*

I have read and agree to the Patient Testimonial Agreement
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Share Your Experience