Prescription Hope Client Testimonials for Our Commercial

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
Your Profile
Name*
First Last
Email
Phone
Address*
Street Address Address Line 2 City State ZIP Code
Upload a photo*
Accepted file types: jpg, jpeg, gif, png, pdf.
Gender*
- Male
- Female
About You and Prescription Hope
Tell us how Prescription Hope has impacted your life.*
Would you recommend Prescription Hope?*
- Yes
- No
Thanks, why?*
We're sorry, why not?*
Phone
This field is for validation purposes and should be left unchanged.

Be Part of a Prescription Hope TV Commercial