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Please tell us your story by filling out the following form. We truly appreciate your feedback.

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Please Review Our Legal Agreement

I hereby authorize my testimonial to be used for testimonial advertisement in Shane R. Hanzlik, MD, PC’s promotional material, including Shane R. Hanzlik, MD, PC’s website, brochures, and advertisements. I waive the right of prior approval and hereby release and discharge Shane R. Hanzlik, MD, PC and all persons acting under the permission and authority of Shane R. Hanzlik, MD, PC from liability, damages, compensation or actions of any kind based on the use of my testimonial or information in the testimonial.

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