Share Your Story

We love to feature our “IRH Graduates” on social media! By sharing your story, you can celebrate your triumph over infertility and inspire hopeful parents who are still fighting their own fertility battles.

Here’s how to participate:
Submit one photo and a few sentences about your story and experience with IRH.

Upload Your Photo

Share Your Story!

AUTHORIZATION FOR MEDIA AND PUBLICATION CONSENT AND RELEASE FORM:

I/We grant permission to the Institute for Reproductive Health (IRH) and its subsidiaries and affiliates to use my/our name and photographs and submitted written story in the media in electronic/digital forms of media or printed matter for use in publication and marketing materials.

I/We understand that the media obtained may relate to my (or the patient’s) personally identifiable health information and/or medical care and treatment.

I/We hereby waive any right to inspect or approve the finished photographs or text media in printed or electronic matter that may be used now or in the future, whether that use is known to me/us or unknown, and I/we waive any right to royalties or other compensation arising from or related to the use of the photographs or video media in printed or electronic marketing materials.

I/We hereby agree to release, defend, and hold harmless The Institute for Reproductive Health and its subsidiaries and affiliates, including any firm publishing and/or distributing the finished product in whole or in part, whether on paper or via electronic media, from and against any claims, damages, or liability arising from or related to the use of the photographs/video/written text media in marketing materials.

I/We have read this release before signing below and fully understand the contents, meaning, and impact of this release.

This consent will remain in effect until I communicate a revocation in writing to: Institute for Reproductive Health Attn: Practice Manager 3805 Edwards Rd Suite 450 Cincinnati OH 45209

First Name

Last Name

Today's Date

Phone

Keep an eye on our Facebook and Instagram account!

Share Your Story

AUTHORIZATION FOR MEDIA AND PUBLICATION CONSENT AND RELEASE FORM:

QUICK LINKS

LOCATIONS