Patient Feedback/Testimonial Form

We love to hear from you! Please share your experience with Dr. Jurek and her staff. You can submit a patient testimonial that may be posted on our website. We would like to hear about your injury and treatment, your care by Dr. Jurek and her staff, your achievements, and your return to doing what you love. You can also submit action photos* that can be viewed along with your testimonial. Thank you for your submission!

*You are able to upload an action photo.  There is a field to upload a file, you have the option to submit a file at that time. Files can be submitted as an Office file or most picture format files (i.e., JPEG).

*Indicates Required Field