Patient Stories
- Dianne
- Kristin
- Bryan
- Peter
Talk with a Patient
- Sign up

Sign up to Talk with an Ambassador

Fill out the form below to be contacted by a Medtronic DBS Therapy volunteer.

By completing this form you are granting Medtronic permission to add your contact information to its database for deep brain stimulation and consent to receiving information and communications related to Medtronic products and therapies.

First name (required)
Last name (required)
Street address 1 (required)
Street address 2
City (required)
State *
ZIP/Postal Code (required)
Email address (required)
Phone number (required)
How would you prefer to be contacted? *
Who would you prefer to speak with? *
What is the best time of the day to call? *
Do you currently have a Medtronic DBS system? *
Yes
No
What topics would you like to discuss with the volunteer who receives DBS?

You may revoke permission to include your contact information in Medtronic's database at any time by emailing support@medtronicdbs.com or sending a request in writing to: Medtronic, Discover Medtronic DBS, 7000 Central Avenue NE, RCE 250, Minneapolis, MN 55432-3576.

Medtronic respects the confidentiality of personal information. We assure you we will not share your personal information, except as otherwise noted in our privacy policy.

Last updated: 13 Aug 2012

Print Page
E-mail Page
A
A
A Text Size

Sign up to Talk with an Ambassador

Find a Specialist