Share Your Story - Passy-Muir

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We'd love to hear about your experience using the Passy-Muir® Valve. What were your first words using the Valve? Do you have anything you'd like to tell other people who are interested in using the Passy-Muir Valve? *

The undersigned hereby authorizes Passy-Muir, Inc. to

include patient's full name in media produced by Passy-Muir Inc.
include patient's image in media produced by Passy-Muir Inc.
include my statements in media produced by Passy-Muir Inc.
Do not include patient's name in media produced by Passy-Muir Inc.

The undersigned hereby authorizes Passy-Muir, Inc. to use images or video of patient in Passy Muir advertisements and other educational and marketing materials. (Guardian or parent's signature, if patient is a minor) *

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