Patient Advocacy Intake Form

To be completed by the orthopaedic patient of an AAOS member.

Do you have a relationship(s) with your U.S. Representative or Senator?
What AAOS advocacy issues have impacted your orthopaedic care? (check those that apply)
I would like to be contacted about healthcare advocacy and grassroots activities and how I can assist with AAOS Advocacy efforts.

Release and Disclaimer:
I understand that AAOS may photograph and digitally record the images or voices of participants in the Patient Advocacy Program. By participating in the Program, I am authorizing AAOS to so capture my image and voice and I grant AAOS permission to use them in Program materials, including brochures, website, news articles, videos and social media posts that are developed to educate AAOS members, public and federal legislators on patient health advocacy concerns. I have no expectation of being paid for this release and disclaimer and I release AAOS, its officers, directors, employees, affiliates and agents from any liability, loss or damage resulting from my participation in the Program.

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