TESTIMONIAL SUBMISSION FORM Required Patient NameStateSelect StateALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWYCityCondition Treated—AllergiesAnxietyArthritisChronic PainDepressionDysmenorrheaHypertensionInfectionInfertilityInsomniaMigranesOtherPneumoniaUterine FibroidsEnter Other Condition TreatedTestimonialWhat do you think about us?PhotoWould you like to include a photo?Star ratingrating fieldsWould you like to include star rating?Consent to ShareI agree to the statement belowI allow NCCAOM to use this testimony on their website or social media outlets. I understand that this testimony is for the promotion of the Acupuncture and Oriental medicine profession.