• Fibrosis Education Model Form

    Please fill out your personal details and tissue condition information. Upload relevant photos and review the privacy disclaimer.

  • Project: Radiation & Lymphedema Fibrosis Clinical Education

    This is the most requested topic from both my patient community and healthcare clinicians. I am creating a new educational resource to showcase effective treatment options for tissue tightness and fibrosis, and I am looking for local models to help demonstrate these techniques.

    What to Expect:

    Location: In-person filming in the Twin Cities area.

    Availability: Looking for 1-3 individuals with flexibility to come in to Kelly's clinic for a 1-2 hour session in the next 1–2 months.

    Clinical Benefit: You will receive specialized treatment during the filming session focused on your specific areas of fibrosis. As a thank you, a modest honorarium will also be provided for your time.

    Privacy: We prioritize your comfort. For areas like the arms, legs, or chest wall, we will use camera angles to keep you anonymous. For face or neck fibrosis, we will do everything in our power to minimize identifiable views while still showcasing the tissue work.

    Please fill out the details below to see if you would be a good fit for this project.

  • Format: (000) 000-0000.
  • Which best describes your tissue tightness?*
  • Date of last radiation*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Do you use compression?*

  • For radiation fibrosis, please film yourself slowly moving the affected area (e.g., raising your arm or pressing on your skin). For lymphedema, please film a 3-second "thumb-press" so I can see the tissue displacement.

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  • Which days/times generally work best for you?
  • Clinical Review & Selection Disclaimer

  • By submitting these images, you agree that Kelly Sturm and the Cancer Rehab PT team may review them to determine if your case is a match for our upcoming educational filming. For General Submissions: If your image is selected for use in a content, you will be notified and compensated according to our standard image rate. For Local Models: If you are selected as an in-person model, a separate Media Release and Agreement will be provided for your signature prior to any filming.

  • Privacy & HIPAA Disclaimer

  • Data is collected via secure, industry-standard SSL-protected forms and is automatically transferred to our HIPAA-compliant Workspace for storage and clinical review. Submissions are automatically deleted from our collection platform to further protect your privacy. We prioritize your privacy and will never share your identifiable information without your explicit separate consent. By submitting this form, you consent to the collection and use of your information for clinical assessment purposes. 

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