Share Your Story!

As we celebrate 16 years of ChiroWay, we’re taking a moment to reflect on the people who have been part of the journey. Thank you for being part of what makes ChiroWay what it is today.

This quick form takes about 3–5 minutes, we appreciate you sharing your experience.

Endorsements will not be shared without prior consent captured.

Name(Required)

First Last

Email(Required)

Phone

Please Select Your Location(Required)

How long have you been a ChiroWay client?(Required)

What originally brought you into ChiroWay?(Required)

What keeps you coming back to ChiroWay? What has kept you consistent with your care over time?(Required)

What changes have you noticed over time with consistent care?(Required)

What would you tell someone who is thinking about starting care at ChiroWay?(Required)

Anything you’d like to share about your experience with ChiroWay?

How would you prefer to share your name?(Required)

Consent(Required)

ChiroWay® Endorsement & Media Release Agreement

Effective Date: April 2026

Endorsement & Media Use Authorization

By submitting a testimonial, endorsement, story, photo, video, or any related content to ChiroWay®, and consent via the checkbox on the form, you agree to the terms outlined in this Endorsement & Media Release Policy. Consent must be captured with the submission, or we do not use that endorsement for marketing purposes.

This agreement applies to all individuals who voluntarily provide content to ChiroWay®, including clients, franchisees, and community members.

Purpose of Use

ChiroWay®, its affiliated entities, franchisees, successors, assigns, and representatives (“ChiroWay”) may use submitted content for the purpose of sharing experiences, educating communities, and promoting the ChiroWay model of care.

Content may be used across:

Websites and landing pages
Social media platforms
Printed materials
Email and SMS communications
Paid advertising (including Meta, Google, YouTube, and other platforms)
Internal training and education
Franchise development and recruiting materials
Any other media formats now known or developed in the future

Content may be used across multiple ChiroWay locations, regions, and markets.

Grant of Rights

By submitting content, you grant ChiroWay a perpetual, worldwide, royalty-free license to:

Use, reproduce, publish, and distribute your endorsement
Edit, adapt, and modify content for clarity, formatting, and length
Create derivative works (including combining with other content)
Use your name, likeness, voice, image, and/or video, if provided

All materials created using submitted content become the property of ChiroWay.

No Compensation

All endorsements and submissions are provided voluntarily.

By submitting content, you acknowledge that:

No financial compensation, royalties, or future payments will be provided
You waive the right to review or approve final materials
ChiroWay has full discretion in how content is used and presented
Content & Privacy

Submitted content may include:

Personal experiences and feedback
Name (based on selected preference)
Photos, videos, or recorded voice (if provided)

ChiroWay will not disclose protected health information (PHI) without separate written consent, in accordance with applicable privacy laws, including HIPAA.

Location Identification

ChiroWay may reference the location where services were received, unless otherwise restricted by the individual’s stated preferences at the time of submission.

Location references may include:

Specific center (e.g., “ChiroWay of Woodbury”)
General geographic area (e.g., “Minnesota”)
No location, if requested
Results Disclaimer

By submitting content, you acknowledge that:

Experiences shared are individual and personal
Results and experiences may vary from person to person
Endorsements do not guarantee outcomes
Content is not intended as medical advice or a substitute for professional care
Right to Revoke

You may request to revoke this authorization at any time by submitting a written request to:

ChiroWay Privacy Officer
Trent@chiroway.com

Please note:

Revocation applies to future use only
Content already published or distributed may not be retrievable
ChiroWay will make reasonable efforts to discontinue future use upon request
Minors

For individuals under the age of 18, a parent or legal guardian must provide consent on their behalf at the time of submission.

Acceptance of Terms

By submitting content through any ChiroWay form, platform, or communication channel, you acknowledge that:

You have read and understand this policy
You voluntarily agree to these terms
You are at least 18 years of age, or have guardian consent if under 18
Contact Information

For more information or to report a privacy concern, contact:

ChiroWay Privacy Officer:

Trent Scheidecker, DC, DACP, AMPT, CFE

franchise@chiroway.com

I agree to the ChiroWay® Endorsement & Media Release Agreement

Signature(Required)

Please type your name to sign and agree to our Endorsement Release Policy