About Us

Caregiver Submission Form

Thank you for your interest in featuring yourself or one of your patients in AMRPA’s Our Stories! Please fill out the fields below and a member of our team will be in touch with you shortly.

To submit as a patient or on behalf of a patient, go here.
Section 1: Contact Information
Your Name

First Name
Last Name
Your Phone
Area Code - Phone Number
Your Email
Patient's Name
Patient's Age
Patient's Livelihood
Name of Hospital Where Patient Received Treatment
Section 2: Open-Ended Questions
What is your relationship to the patient?
What were the patient’s diagnosis and prognosis?
Describe the patient’s treatment plan. What were the results?
What challenges did you face as the caregiver?
What resources helped you as you helped your loved one through their recovery?
What advice would you give to other caregivers?
What message do you want to share with potential patients considering (or who have not yet heard about) treatment in an inpatient medical rehabilitation setting?
What are some closing statements or remarks you have that you believe would resonate with our readers?
Please share any relevant photos with us for publish alongside your story on our website and on social media.
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