Name* First Last Email* Your Naturopathic Doctor's Name* First Last Your City and State* City State / Province / Region Tell us how Naturopathic Medicine helped you:Your PhotoMay we share your story for publication by your state association of naturopathic doctors?* Yes NoIn order to submit this form you must agree to the following terms and conditions:* Yes, you can use my name, photograph and story to promote and support Naturopathic Medicine.I acknowledge that I have checked the box above, and give my consent to The Institute for Natural Medicine (“INM”) to use my name, photograph and story for educational, publicity, marketing, advertising and fundraising purposes through all forms of media.PhoneThis field is for validation purposes and should be left unchanged.
