Stein Hospice Testimonial

Share your LOVE for Stein Hospice!

Valentine’s Day may have passed, but it’s still February, the month of love! To celebrate, we are asking you to provide a loving testimonial to be shared on our website, social media platforms, and even possibly in our quarterly newsletter.

You have several options including a written testimonial or a video testimonial. You can choose to share pictures, or just your words. It’s very simple. Just complete the form below and you’re done!

If you have any questions, please contact Shelby Brossia at 419.202.2036.

Name (of person completing this form)(Required)

First Last

Phone Number (of person completing this form)(Required)

Email (of person completing this form)(Required)

Please explain your connection to Stein Hospice:(Required)

(i.e. if your loved one was a patient, please list their name and the dates they were in our services. Or perhaps you used our bereavement services or were involved in our Navigator Program).

Select Your Format

There are two options for submitting a testimonial: 1. written format (with or without a photo) or 2. video format (pre-recorded or recorded by Stein Hospice). Please select the option you choose to complete.

Written Testimonial:(Required)

Please type your experience with Stein Hospice to be shared on our social media pages as well as our website (and possibly our quarterly newsletter).

Photo (to be included in publication)(Required)

Please upload a file that you wish to be included with publication of your written testimonial.

Max. file size: 128 MB.

Video Link(Required)

Please copy and paste the link to your video testimonial here.

Contact Dates/Times(Required)

If you have selected the option for a Stein Hospice employee to video record your testimonial, someone will be in touch with you shortly. Please list the best days/times to get in touch with you.

Consent(Required)

By checking the box below, I agree to allow Stein Hospice to use my words and images in publicity materials including, but not limited to, websites, social media, and quarterly newsletters. I understand that my words may be slightly altered for the purposes of these platforms. If the words are altered, I will be notified before publication and given the opportunity to make adjustments.

Yes, I understand and give permission