Thank you for choosing Knoxville Hospital & Clinics (KHC)
for your health care! Our mission of faithfully providing
exceptional health care affects every decision we make and how we care for our patients and families.
If you are willing to share a testimonial about your experience at KHC, we would love to hear from you! Please note - your story may be shared broadly through KHC marketing materials, including Facebook, Instagram,
KHC website, and brochures.
If you would like to make a gift to the KHC Foundation, we appreciate all donations, large and small. As a 501(c)(3) organization, all gifts to the KHC Foundation are tax-deductible to the fullest extent of the law. To make your donation today, click here.
I understand my testimonial as outlined and made on behalf of Knoxville Hospital & Clinics may be
used in connection with publicizing and promoting the Hospital. I authorize the Hospital to use my
name, brief biographical information, and testimonial as defined on this form.
I hereby irrevocably authorize the Hospital to copy, exhibit, publish, or distribute the testimonial for
purposes of publicizing the Hospital’s services or for any other lawful purpose. My testimonial may
be used in printed publications, multimedia presentations, on websites, or in any other distribution
I understand that my health care and the payment for health care will not be affected if I do not sign
this form. I understand that I will make no monetary or other claim against the Hospital for use of the
I understand I may revoke this authorization at any time by notifying the Compliance Officer of
Knoxville Hospital & Clinics, but if I do so, it will not have an effect on any actions taken before the
revocation is received.
In addition, I waive any right to inspect or approve the finished product, including written copy,
wherein my testimonial appears.
I have read the authorization and release of testimonial information and give my consent for the use
of my testimonial as indicated.