Patient and Care Partner Art Submission

If you are a patient or care partner who wants to share your art as a way to humanize healthcare, please complete the below form.

Title of Artwork(Required)

Name(Required)

First Last

Address(Required)

City State / Province / Region

In one paragraph, please share some of the background as a patient and family member relevant to the artwork(Required)

Email(Required)

Headshot of the Artist(Required)

Drop files here or

Max. file size: 50 MB.

Artwork(Required)

Drop files here or

Max. file size: 50 MB.

Acknowledgments(Required)

I authorize The Beryl Institute to share this artwork on its website, social media platforms and email communications. I acknowledge that I hold all necessary rights and permissions for any content in this submission. I confirm that I am solely responsible for ensuring that no copyrighted or unauthorized material is used without proper licensing or consent. I further understand that I am fully liable for any legal actions, penalties, or fines resulting from the use of unlicensed or unauthorized images or content. I agree to indemnify and hold harmless The Beryl Institute, its affiliates, and any related parties from any claims or damages arising from violations of intellectual property rights related to the content I provide.