Staff Testimonial Interest Form

We’re excited you’d like to share your story! Your experiences showcase what makes Lake Butler Hospital truly special. Please complete the form below with thoughtful and detailed responses. Your story matters, and it helps inspire others while building our community. Note: By submitting this form, you agree to allow us to use your responses in marketing and promotional materials.

Name

First Last

Department / Role:

Length of Service at Hospital:

Phone:

Email:

Please share three dates and times you’re available for filming in the next month.

Do you consent to your testimonial, photos, or video being used for marketing purposes, including social media, printed materials, and advertisements?

By typing your name below, you confirm your consent to the use of your testimonial, photos, or video for the purposes described above.

Staff Testimonial Interest Form

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(386) 496-2323

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