Be Part of a Prescription Hope TV Commercial

If you're selected you'll receive a year's worth of free services!

We will be selecting individuals by late August to participate in an upcoming Prescription Hope TV commercial. Please complete this information form and upload photo of yourself by August 10. If you are selected we will contact you by late August with more details. The filming of the commercial will be in September of this year in Columbus, OH area.

ALL SUBMISSIONS ARE DUE BY AUGUST 10, 2017

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About You and Prescription Hope

Tell us how Prescription Hope has impacted your life.*

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