Submit a Testimonial

Please tell us your story by filling out the following form. We truly appreciate your feedback.

* Indicates a Required Field.

Upload a Photo of Yourself:

(Acceptable Formats: JPEG, GIF, PNG)

Please Review Our Legal Agreement

I hereby authorize my testimonial to be used for testimonial advertisement in reVive Spine Center’s promotional material, including reVive Spine Center’s website, brochures, and advertisements. I waive the right of prior approval and hereby release and discharge reVive Spine Center and all persons acting under the permission and authority of reVive Spine Center from liability, damages, compensation or actions of any kind based on the use of my testimonial or information in the testimonial.

By signing below, I agree and acknowledge that I have read and understood the above Release and agree to all terms described. I am of legal age and freely sign this consent to release my patient testimonial.

(Typing your name here indicates that all of the above information is accurate and acts as your electronic signature.)

Contact Us

Niagara Falls/Wheatfield

6941 Williams Road, Niagara Falls, NY 14304


505 Delaware Avenue, 2nd Floor, Buffalo, NY 14202

Amherst Location

Northwoods Medical Center

3950 East Robinson Road, Suite 109, West Amherst, NY 14228

Orchard Park

Located adjacent to the MACC Center in the medical building.

3671 Southwestern Blvd, Suite 207, Orchard Park, NY 14127
See All Locations