Axonics Patient Ambassador Program Applicant Terms
Program Description: The Axonics Patient Ambassador Program connects prospective patients with individuals who have already been implanted with an Axonics medical device. The Patient Ambassador Program provides each volunteer the opportunity to advocate on behalf of those suffering from urinary or fecal dysfunction, answer questions, and share personal stories and experiences about Axonics Therapy. Patient Ambassadors do not offer medical advice.Authorization and Terms of Use: By submitting your application, you acknowledge and agree to
the following:
- I am voluntarily sharing my personal information, including health information, with Axonics for the purposes of applying to be a volunteer (unpaid) Axonics Patient Ambassador.
- By enrolling in the Program, I authorize Axonics to contact me by phone, email, or text message, and I understand that airtime, message, and data rates may apply.
- I understand that Patient Ambassadors are not Axonics employees.
- I am currently implanted with an Axonics medical device.
- I am eighteen (18) years of age or older.
- I understand that submitting an application does not guarantee that I will be selected to be a Patient Ambassador.
- I understand that Axonics has sole discretion in selecting Patient Ambassadors.
- If I am selected by Axonics to be a Patient Ambassador, I understand that my participation is conditioned upon the execution of an Axonics Patient Ambassador Participation Agreement.
- I authorize Axonics to contact me to request additional information or discuss my application.
- If I am selected by Axonics to become an Axonics Patient Ambassador, I understand that Axonics will make my name and contact information available to Ambassador Program Members and will publicize my position as an Ambassador through newsletters, social media, the Axonics website, occasional mailings, and print brochures.
