Share Your Story

 

If you have been a patient of Dr. Jemsek or Jemsek Specialty Clinic and would like to share your story, please submit your testimonial. Testimonials may be chosen to be featured on our website or expanded into a Patient Profile.

 
 
Name *
Name
Please provide the year(s) in which you received treatment.
In your own words, describe your treatment experience with Dr. Jemsek or Jemsek Lyme Clinic. Write as if you were speaking to a friend. Please write in first person ("I") and do not directly address Dr. Jemsek or staff, but rather write as if you were talking to a third person. (For example: "I was Dr. Jemsek's patient..." instead of "Dear Dr. Jemsek, etc.")
Phone Number *
Phone Number
Please include a phone number where you can be reached directly. This will only be used if we have a question or if we need to follow up with you. This will not be shared or posted publicly.
Best Time To Call *
Best Time To Call
Please include the best time to call you on the number provided above to follow up with you.
Please indicate how you would like your identity to be represented on our website, should we publicly post this testimonial.
If in the United States, indicate the state. If not in the United States, indicate the region, territory, county, or district, as appropriate.
Release *
By checking the below box, you agree to release the use of the above text, including any minor revisions deemed necessary for grammar and clarity, to use for Dr. Jemsek and Jemsek Lyme Clinic. If selected, you agree that your testimonial may be listed publicly on the Jemsek website and other places. You agree that your location of residence be included along with your testimonial. The representation of your identity indicated above will be included, as well.
Certification *
By checking the below box, you certify that the above provided information is correct and accurate.