Social Status

We want to hear from you! Please use this form to share current Practice events, recent news, or updates that can be shared on our Practice's social media pages. Please note that photos are required.

First Name: *

Last Name: *

Job Title: *

Phone Number: *

Email Address: *

*This information will only be used to contact you with any additional questions regarding your submission.

Upload Photo/Choose File *

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png.

Please provide us with a detailed description of the photo and the reason you hope to see it featured on Black Hills Orthopedic & Spine Center's social media pages by answering the following questions:

Photo Details:

Where was this photo taken? *

When was this photo taken? *

Why was this photo taken? *

Who is pictured in this photo? *

Please provide a description of the individual(s) in the photo with his/her name(s) to help us differentiate between all individuals photographed (i.e., man on far left wearing red t-shirt).

Individual #1:

First Name: *

Last Name: *

Description: *

Individual #2:

First Name:

Last Name:

Description:

Individual #3:

First Name:

Last Name:

Description:

Individual #4:

First Name:

Last Name:

Description:

May we release the names of the individuals pictured on our social media pages? *

Yes

Other: (i.e., one person can be mentioned but not all people photographed)

May we release the names of the individuals pictured on our social media pages? Other: (i.e., one person can be mentioned but not all people photographed)

Do we have permission to publish your submission, in its entirety or in part, on our social media pages? *

Yes

Is anyone under the age of 18 in the photo(s)? *

Yes

Please provide any additional details you would like to see included with this submission on our social media pages: *

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