Student-Athlete Rebound Story

Rebound Orthopedics & Neurosurgery is proud to partner with the Oregon School Activities Association (OSAA) as the Official Sports Medicine and Orthopedic Partner for student-athletes across the state. Together, we share a commitment to supporting athletes at every level—from injury prevention to the comprehensive, sports-focused care that helps them recover and confidently return to the sports they love. We want to celebrate your comeback! Share your story below and inspire the next generation of Oregon student-athletes.

About You

First Name

Last Name

Age at Time of Procedure

What school do you attend?

What sport do you play?

Upload Image

Please upload an image of you returning to your sport or training.
(No selfies, graphic images, blurry images, or medical scans, please.)
One file only.
256 MB limit.
Allowed types: gif, jpg, jpeg, png.

Phone

Where Are You From?

City

State

Medical Information

Rebound Doctor Name

Treatment Performed

Did you see a physical therapist at Rebound Orthopedics & Neurosurgery? If yes, who?

Your Story

Title

Story

GPA

Letter of Recommendation from a School Staff Member (i.e. Coach, Administrative Staff, Teacher)

One file only.
256 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Media Consent

You must review and accept the Authorization before submitting this form.

AUTHORIZATION TO USE PHOTOGRAPHIC OR DIAGNOSTIC IMAGES, VIDEO, OR AUDIO

I, the undersigned, do hereby consent and agree that Rebound Orthopedics & Neurosurgery (“Rebound”) and its staff, agents, successors, and assigns may use and publish this Rebound Story and any related photographs, images, videos, audio recordings, or diagnostic images supplied or authorized by me for educational, promotional, marketing, publicity, or other related purposes.

This authorization includes:

Use by Rebound and/or by third parties, including the media.

Permission for my name and identity to be revealed in connection with the story, including descriptive text or commentary.

I understand and agree that:

The materials may be used publicly or privately, including on websites, social media, print materials, advertisements, or other publications.
I waive any right to inspect or approve the finished product.
I waive any right to compensation or additional consideration.
I waive any claims or interests I may have in the materials or their use.

Revocation: This authorization will remain valid unless and until I submit a written revocation request. Revocation requests must be submitted in writing to Rebound’s Privacy Officer at: medicalrecords@reboundmd.com. I understand that revocation will apply only to future uses and that Rebound will be given a reasonable amount of time to remove previously authorized materials.

Name: [webform_submission:values:first_name] [webform_submission:values:last_name]

Date of Birth

Signature

Sign above

Date:

If you are under 18 and submitting this form, please select the box below and provide the contact information for your parent or legal guardian. If you are selected for the scholarship, we will contact them directly to obtain consent.

Age Verification

I am under 18

I am 18 years or older

Parent/Legal Guardian Name

Parent/Legal Guardian Phone Number

Parent/Legal Guardian Email

THIS FORM DOES NOT AUTHORIZE THE DISCLOSURE OF WRITTEN OR PRINTED MEDICAL RECORDS.