Private Review: I DO NOT give permission for use of any quotation and/or comment made by written, verbal or recorded method for the purpose of public review submission. I understand that my comments and identity may be seen by various staff members at Newman Regional Health and give them permission to use and disclose said content and identity to staff members. I give consent to be contacted by representatives of Newman Regional Health This consent is granted on the date of submission of this form and will last until revoked in writing to the Business Development Director at 1201 West 12th Ave, Emporia, KS 66801.