About Us

Patient 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 caregiver, go here.
Section 1: Contact Information
Your Name

First Name
Last Name
Your Title
Your Organization
Your Phone
Area Code - Phone Number
Your Email
Patient's Name
Patient's Age
Patient's Livelihood
Section 2: Open-Ended Questions
What was the patient's diagnosis?
What was the prognosis? Did providers expect a full recovery? Did you expect a full recovery?
How did medical rehabilitation assist in recovery/mobility objectives?
Please provide treatment details, how care was delivered and what is remembered most about treatment.
What is the daily care routine/plan? Has it changed? How has it improved since treatment?
What are the motivations to keep going despite the challenges faced?
What message do you want to share with those with similar conditions and those considering treatment in a rehab hospital?
Do you have any closing statements or remarks that would resonate with readers? What would you like to say to medical rehab hospital staff, patients unsure about the benefits of rehab hospital treatment and general industry professionals?
Please share any relevant photos with us for publish alongside your story on our website and on social media. These photos can be during therapy, pre- and post-treatment, with the care team, etc.
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