Provide Testimonial

    I hereby allow Brian R. Gantwerker, M.D., A Medical Corporation / The Craniospinal Center of Los Angeles (“The Practice”) and its representatives to use my testimonial in its promotional materials. This includes but is not limited to: web pages, correspondence, or other print or digital media. I have the right to revoke this privilege at any time. I will submit this request in writing to the correspondence address shown below** and The Practice will comply . I also hereby indemnify and hold harmless The Practice any loss of privacy and its sequelae that this material provides insomuch as I have allowed my information to be disclosed. I have stated my information sharing level preference below.