Complete the form below to view profiles of our ambassadors and schedule an appointment.

Anyone under the age of 18 is not eligible for this program.

* indicates a required field.

Contact Information


  1. 18-24

  2. Male

  3. Tried Injection Therapy for more than 2 months
    Had corrective back surgery
    Experiencing the screening trial for spinal cord stimulation
    Scheduled for a screening trial for spinal cord stimulation
    Experiencing the screening trial for targeted drug delivery
    Scheduled for a screening trial for targeted drug delivery
    Have an implanted Pain Neurostimulator and need a replacement
    Have an implanted Drug Pump System and need a replacement
    None of the above

By completing and submitting this form, you are granting Medtronic permission to add your personal information, including your contact information and basic healthcare information, to its patient database, and to share that information with Medtronic representatives and health care providers as appropriate. We may conduct analyses on information collected in order to make improvements to and provide training on our operations, products, services, and customer communications. Medtronic may de-identify data collected, combining it with data collected from other sources. Lastly, information provided may be shared with your physician for treatment considerations or other purposes. You also agree to being contacted by Medtronic in the future by mail, telephone or by non-password protected electronic communications, such as emails or text messages. Medtronic may exchange information with you regarding our products or services, inquire about your experience, or determine how Medtronic can support you through your journey.

Medtronic respects the confidentiality of your personal information. If at any time you wish to revoke all or part of this permission, you can email us to or send a request in writing to: Medtronic Patient Support, 7000 Central Ave NE, RCE 230, Minneapolis, MN 55432. This permission will expire 10 years after the date of your signature.*

*If you live in Maryland, the consent expires automatically in one year. We may contact you then to see if you would like to renew it.

I agree

Medtronic respects the confidentiality of personal information. We assure you we will not share your personal information, except as otherwise noted in our privacy policy.

Please note: Medtronic Pain Therapies Ambassador Program is not intended to offer medical advice, counseling or product-related technical support. For medical questions, please talk with your doctor. If you have a Medtronic product and need technical support, please call 1-800-510-6735.

Your discussion with an ambassador is meant to be a one-on-one conversation with an actual pain therapy patient. The ambassadors are instructed not to disclose any information about you to Medtronic or anyone else, but Medtronic cannot guarantee this will not happen. Therefore, please do not share any personal information about yourself with the ambassador unless you wish to do so. Medtronic will not participate in or monitor your conversation with an ambassador. The ambassadors are not employees of Medtronic, and Medtronic does not control what they may say to you. For these reasons, Medtronic is not responsible for any statements the ambassadors make. Medtronic encourages you to carefully review the information about Pain Therapies, and to discuss the therapies with your doctor.

We reserve the right to end the Ambassador Program at any time. You may request literature about Medtronic pain therapies from your healthcare provider or by visiting . We encourage you to carefully review the information on the website and to discuss therapy options with your doctor.