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Home >> | What is Neurosurgery

Do you have a compelling story that is worth sharing with the public?  The American Association of Neurological Surgeons (AANS) is interested in hearing from patients treated by neurosurgeons.  Parents may submit stories on behalf of their children, and family members may submit stories on behalf of immediate relatives.  The goal of this AANS public outreach project is to help educate people about the role of the neurosurgeon in treating a wide range of medical conditions and diseases.

All fields must be filled in, unless otherwise stated.  If you have any difficulties with the submission process, please contact Betsy van Die at bvd@aans.org.

Click here to view and download the Neurosurgical Patient Stories flier.

**  This information used for internal reference by AANS only.

Submit Your Neurosurgical Patient Story

Patient

Salutation:
Firstname:  
Middle Initial:
Lastname:  
Suffix:
Address:  
City:  
State:  
Zip: **  
Country:
Phone:  **  
Email:  **  
Occupation:
Current Age:  
Age at time of treatment:  
Gender:
 

Neurosurgeon Name

First:  

Last:  

 

Diagnosis

Condition:  

Date of Diagnosis:  

 

Hospital

Name:  

Location:  

 

Surgery

Procedure:  

Date(s):  

          

 

Story   

 

Please indicate if you have a photograph you would like to submit.  Instructions will be sent to you following acceptance of your story.

 

Terms of agreement

I authorize the AANS to use my story submission in public relations, collateral and public awareness materials, including posting on www.NeurosurgeryToday.org.  I understand that my submission may be edited to adhere to word count guidelines inherent to specific projects.

I authorize the AANS to use my submitted photographs in public relations, collateral and public awareness materials, including posting on www.NeurosurgeryToday.org.

I understand that there will be no monetary compensation unless otherwise stated for submission and usage of my story and or photographs.  My personal contact information will not be published.  Publication of my story is up to the sole discretion of the AANS.

I certify that I have read the above authorization and release and fully understand and agree to its terms.

   

 

 

 


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