Chronicle Submission Form

We invite all patients, regardless of your treatment modality to share your experience. This is a forum to share and learn about one another. Please write your text in the box provided below. The text will be edited for spelling or grammar, however, no text will be changed that would affect the historical accounting or factual details. Peninsula BioMedical reserves the right to review all submissions prior to posting to ensure appropriateness. Anything not appropriate for this forum will not be publis hed . Thank you for sharing, this will provide an invaluable accounting for lymphedema sufferers and an insight to others who's life has been touched by lymphedema.

Title: (optional)
Your Chronicle:

Your Email:
* We require your email address for all submissions*

Check this box if you agree to the following terms. It is required to agree to these terms before we can accept your chronicle.
It is agreed and understood that the information I am submitting will be placed on a public website. I release Peninsula BioMedical, Inc. and all people that may come in contact with this information from any and all liability resulting from the publication and duplication of this information. I have entered this agreement in order to assist in education, research and public relations and hereby waive any right to compensation for such use. Should any p hot ographs be submitted, I acknowledge that by permitting use of the photographs, I am consenting to the disclosure of information. I reserve the right to not have my true name disclosed, however, should the information submitted contain my name, this is to be considered consent to use this information.