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Windswept Hair
Consent and Testimonial Submission

I understand that by filling in the above name fields, I am providing my authorized signature to consent to the use of my testimonial as described below, and that Samaritan will contact me to confirm this authorization.

Permission to Publish

Samaritan will not publish your full name, phone number, or email, nor share them with another person or entity.

By providing my full name above, I acknowledge/understand that the written testimonial I provide may be used by Samaritan Counseling, Guidance, Consulting, in full or in part, for marketing/advertising purposes. My testimonial may be distributed via Samaritan's website, social media pages, and used in promotional materials, printed and/or posted online, such as brochures, the annual report, newsletters, and flyers.

Expiration - I have the right to revoke this consent at any time and may do so by calling 412.741.7430 and providing my full name, call-back number, and my stated request to revoke my consent. If I revoke consent, Samaritan will remove my testimonial from online platforms and will cease to print/post it in the aforementioned materials going forward. However, I understand that any printed materials that included my testimonial that had already been distributed will not be retrievable. Furthermore, I understand that previous online posts, although deleted, may still appear in some searches.

My Testimonial

Happy Mother with her Child
Hiding a Smile
Smiling Mature Man

Thanks for sharing!

Thank you for your willingness to share! By sharing, you give hope to others who read your story.

Lasting Smile
Smiling Young Man
Elegant Older Woman
Young Beautiful Girl