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Share Your Story

Share your story and help inspire those seeking fertility treatment

  • Your last name is for identity verification purposes only. It will not be used unless you use it in the story part of your submission.
  • Your email will only be used if we have questions or need to contact you after your submission. It will not be published.
  • Your phone number will only be used if we have questions or need to contact you after your submission. It will not be published.

  • Photos for Website (horizontal)

    Please submit at least two photos in landscape/horizontal format. You can crop them after you upload.

  • Photos for Social Media (vertical)

    Please submit at least photos in portrait/vertical format. You can crop them after uploading.

  • Treatment Basics

  • Where your retrieval, transfers or inseminations happened

  • Your Inspiring Story

  • Share your inspiring success story in as much detail as possible. It may be helpful to draft this in a word document and copy paste onto this form. We find the best stories start around the time when you began trying to conceive (or even when you met your partner/fell in love - if applicable). Be sure to include how long you were trying to conceive before seeking treatment, how many treatment cycles you went through and as much detail as possible.
  • Describe the moment you found out you were pregnant (or first held your child) and all the amazing emotions you felt.
  • Advice to others What do you wish you knew when you started TTC/ what advice would you have for someone just starting their journey?
  • What resources did you find during your journey that were helpful. Did any other activities (yoga, meditation, journaling etc.) help?

  • Terms & Conditions

    PURPOSE OF AUTHORIZATION

    I hereby authorize CNY Fertility to copy, exhibit, publish and distribute my client testimonial for marketing and other lawful purposes, including but not limited to posting my client testimonial on the CNY Fertility website and its social media pages, and in printed advertisements and promotions. I agree that I am voluntarily shar-ing my testimonial about services from CNY Fertility, and will not make any monetary or other claim against CNY Fertility for use of my testimonial (including my protected health information contained in the testimoni-al) for marketing purposes.

    Right to Revoke

    I understand that I have the right to revoke this authorization at any time by providing a written request to the Privacy Officer at CNY Fertility. I understand that if I choose to revoke this authorization, it will become effec-tive on the day the written revocation is received by CNY Fertility. Any prior uses and disclosures of my testi-monial with my protected health information will not be subject to the revocation of the authorization; how-ever, I understand that CNY Fertility will make it best effort to remove my testimonial and protected health information from the CNY Fertility’s website and its social media pages.

    Components of my Testimonial

    I understand that the client testimonial for CNY Fertility will only include my name, location, photograph, and information provided to the organization in my testimonial. I understand that all other protected health in-formation that CNY Fertility creates and maintains for purposes of my care will not be used in my testimonial or for marketing purposes without prior authorization per privacy regulations of the state and Health Insur-ance Portability and Accountability Act (HIPAA).

    I agree and acknowledge that I am the primary subject of the submitted story and that I am the sole owner of any and all copyrights to photographs and images that I submit to CNY Fertility.

    I agree and acknowledge that I have read and understood all of the elements of this authorization for use of my client testimonial.