Ambassador Intake | Medtronic Canada

Welcome to the Medtronic Canada Patient Ambassador Program for the InterStim™ Therapy. Through this process, you can become an ambassador and share your personal experience with InterStim™ therapy for Overactive Bladder, Fecal Incontinence or Non-obstructive urinary retention to people who are considering this therapy.

You will not be expected to provide medical advice nor answer technical questions about the therapy. Connections with patients will be at timings and frequencies of your convenience.

The information you provide below will only be used for the purposes of the Patient Ambassador Program. Your information will not be used for any purposes.

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First Name

Last Name

I consent to Medtronic collecting and using the personal information I provide to contact me regarding and to administer my registration for the Patient Ambassador Program. I understand that, if selected to participate, I will be asked to review and sign a separate Patient Ambassador Agreement. I acknowledge that I have reviewed Medtronic's Privacy Notice

I am interested in becoming an ambassador

Canada

Customer Care Team