Submit your Story

We would love to hear your story!

If you’d like to share your story, we ask you to sign and submit an Authorization Form which protects you and the private health information you provide from the unauthorized release of private medical information. The information is stored securely and will never be sold or shared with any third party.

Once you have completed, signed and attached the Authorization Form, please complete the below contact information fields, briefly share your story in the provided box, and hit the “SEND” button. Once we receive your signed Authorization Form and contact information, someone will contact you to learn more and discuss the potential of becoming a patient testimonial for Avanos!

  • Download and Fill Out Authorization PDF

    After your information has been entered into the Authorization Form PDF and saved to your computer, click "Choose File" below to attach it.

    NOTE: Do not open the file in a browser, only open it from your computer to save the changes.