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To Submit a video or to have your video edited, please complete the following form and then print. send your DVD and the completed form to:

SurgeryU
ATTN: Erik Rostad
131 Ponce de Leon Ave.
Suite 208
Atlanta, GA 30308

* Required Fields

* Title of Procedure : * Doctor : Procedure
If you can not find your procedure in the list please enter in the list below : 2nd Procedure
If you can not find your procedure in the list please enter in the list below : Techniques
If you can not find your technique in the list please enter in the list below : 2nd Technique
If you can not find your technique in the list please enter in the list below : Diagnosis
If you can not find your diagnosis in the list please enter in the list below : 2nd Diagnosis
If you can not find your diagnosis in the list please enter in the list below : Any Equipment Used (manufacturer and equipment name): Video : (Please Submit Video in MP4, WMV, MPG, or MOV format) Image : (Please size to 80 x 60) Text Document : (Please include detailing steps and procedures.) Audio Commentary : (Please text in Word format) Year : Check if sound : Check if editing is required : Video editing charges: $250 for the first 3 hours of video length and $100 for each additional hour of video.

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