Share Your Story

We want to hear from you!

Tell us about your experience with Hospice!

With your permission, we will share your story to provide encouragement, comfort, and education to others. The end-of-life journey is unique to everyone, and your story has value and impact for our community. By choosing to submit your experiences, you assist us in better explaining the the holistic care and dignified experience that we provide every patient. Your words may be used (in part or whole) in publications, online, and in social media to effectively tell the story of Hospice of Davidson County and the care we provide to our community.

NOTE – Please read the “Publicity Release” description carefully. If you do not check the “Publicity Release” box and submit your name on the Signature line, the information submitted will only be shared internally with HODC staff and will not be shared publicly.

 

By checking this box, I authorize the unrestricted use of my submission by Hospice of Davidson County (HODC) including in publication and on social media. I understand that any information I submit, including Protected Health Information (PHI) such as name and diagnosis, will be in the public domain and not protected by federal privacy standards. I waive the right inspect or approve usage of my submission and agree HODC shall have full exclusive ownership pursuant to this authorization. I claim no right to compensation. I also understand I have the right to revoke this authorization at any time and that HODC must be notified in writing to: Community Relations, 200 Hospice Way, Lexington, NC 27292. I understand that if I revoke this authorization, while HODC will not permit the further release of my PHI beyond the revocation date, it cannot all back any prior use or disclosure of same. I may request a copy of this authorization and ask questions about the use or disclosure of my PHI by calling Community Relations at 336-475-5444. NOTE - If you do not check this box and submit your name on the Signature line, the information submitted will only be shared internally with HODC staff and will not be shared publicly.