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Real Results</a></li></ul></li><li class="item-568"><a href="/patients/is-axonics-right-for-me" >Is Axonics Therapy Right For Me?</a></li><li class="item-569 deeper parent"><span class="nav-header ">Patient Resources</span> <ul class="nav-child unstyled small"><li class="item-571"><a href="/patients/resources-patients/frequently-asked-questions" >FAQ</a></li><li class="item-570"><a href="/patients/resources-patients/resources" >Resources</a></li><li class="item-640 current"><a href="/patients/resources-patients/connect-with-an-ambassador" >Connect with an Ambassador</a></li><li class="item-641"><a href="/patients/resources-patients/connect-with-an-ambassador-thank-you" class="hidden-link">Connect with an Ambassador Thank You</a></li><li class="item-643"><a href="/patients/resources-patients/connect-with-an-ambassador-terms-page" class="hidden-link">Connect with an Ambassador Terms Page </a></li><li class="item-642"><a href="/patients/resources-patients/become-an-ambassador" >Become an Ambassador</a></li><li class="item-646"><a href="/patients/resources-patients/patients-blog" >Blog</a></li></ul></li><li class="item-708"><a href="/patients/#inline-quiz" class="gtm--take-the-quiz">Find A Specialist</a></li></ul> </nav> </main> </div> </header> <section class="totalheight"> <div class="custom-filter-block"> </div> <script> var sssText = ""; // var result = $('div.result'); setTimeout(function () { $('.custom-filter-block').insertBefore('.k2ItemsBlock'); }, 100); $(".btn-filter").click(function () { var dateLink = ""; var currentDate = '2023-01-26'; //this will find the selected website from the dropdown var go_to_url = $(".filter-select").find(":selected").val(); console.log("URL" + go_to_url); //this will redirect us in same window if (go_to_url === "2017") { var go_to_url = "&dtrange=range&sdate=2017-01-01&edate=2018-01-01" } else if (go_to_url === "2018") { var go_to_url = "&dtrange=range&sdate=2018-01-01&edate=2019-01-01" }else if (go_to_url === "2019") { var go_to_url = "&dtrange=range&sdate=2019-01-01&edate=2020-01-01" } else if (go_to_url === "2020") { var go_to_url = "&dtrange=range&sdate=2020-01-01&edate=2021-01-01" } else { var go_to_url = "&dtrange=range&sdate=2019-01-01&edate=2023-01-26" } // console.log(go_to_url); document.location.href = dateLink + go_to_url; }); </script> <style> .small-text { font-size: .75rem; font-weight: bold; } .cfb-flex { display: flex; align-items: flex-end; } .cfb-flex-2 { margin-left: 1.5rem; } .filter-select { font-size: 1rem; color: #939393; padding: .25rem .5rem; width: 400px; } .btn-filter { color: #555; font-weight: bold; cursor: pointer; } @media (max-width: 991px) { .cfb-flex { flex-direction: column; } .cfb-flex-1 { width: 100%; } .filter-select { width: 100%; } } </style> <div class="joomla-content"> <div id="system-message-container"> </div> <div class="item-page"> <div class="icons pull-right"> </div> <div class="blog-inner-social"></div> <section class="newpatients patients-therapy patients hcp patients-ambassadors"> <div class="block-showreel container bg-4-3-connect" role="img" aria-label="Connect with an ambassador"> <h1 class="text-center white-text">Axonics<sup>®</sup> Ambassadors</h1> </div> <div class="block-what"> <div class="container"> <h1>Connect With an Axonics<sup>®</sup> Ambassador to Learn About Bladder and Bowel Control Therapy</h1> <p class="text-center">Are your symptoms disruptive and preventing you from living a fuller life? Would you like to connect with someone who understands the unique challenges of living with urinary or bowel dysfunction?</p> <p class="text-center">Patient Ambassadors are volunteers who are ready to speak with you to share their real-life experiences and answer your questions about Axonics Therapy. Talk to them one-on-one and learn how their lives have changed for the better.</p> <p class="text-center"><b> Why wait? It’s time to live a fuller life. </b></p> <section class="patients-step patients-step--ambassadors"> <article class="patients-step-item"> <div class="patients-step-item_number">1</div> <div class="patients-step-item_title"> </div> <div class="patients-step-item_text">If you’d like an Ambassador to contact you, call us toll free at <a class="phone-link" href="tel:1-877-9-AXONICS">1-877-9-AXONICS</a></div> </article> <article class="patients-step-item"> <div class="patients-step-item_number">2</div> <div class="patients-step-item_title"> </div> <div class="patients-step-item_text">We’ll ask you a few questions to help us locate a Patient Ambassador with a situation similar to yours.</div> </article> <article class="patients-step-item"> <div class="patients-step-item_number">3</div> <div class="patients-step-item_title"> </div> <div class="patients-step-item_text">A Patient Ambassador will be provided with your information and will contact you.</div> </article> <article class="patients-step-item"> <div class="patients-step-item_number">4</div> <div class="patients-step-item_title"> </div> <div class="patients-step-item_text">You can openly discuss any questions you may have via phone or by email.</div> </article> </section> </div> <div class="container"> <h4>Patient Ambassadors are ready to talk to you confidentially to explain how their lives have changed for the better.</h4> <h4 class="green-text">Eliminate doubt. Contact us today.</h4> If you would like a Patient Ambassador volunteer to call or email you, please fill out the form below. <div> </div> <div class="ambassador"> <div class="ambassador-form"> <p><sup class="required">*</sup> Indicates required field</p> <form class="connect-ambassador" novalidate action="/ambassador/submit-ambassador.php" method="POST"> <div class="form-group"> <label for="first-name">First name<sup class="required">*</sup></label> <input type="text" class="form-control" id="first-name" name="first-name" placeholder="What is your first name?" required> <div class="invalid-feedback">This field cannot be left blank</div> </div> <div class="form-group"> <label for="last-name">Last name<sup class="required">*</sup></label> <input type="text" class="form-control" id="last-name" name="last-name" placeholder="What is your last name?" required> <div class="invalid-feedback">This field cannot be left blank</div> </div> <div class="form-group"> <label for="phone">Phone number<sup class="required">*</sup></label> <input type="text" class="form-control" id="phone" name="phone" placeholder="What is your phone number?" required> <div class="invalid-feedback">This field cannot be left blank</div> </div> <div class="form-group"> <label for="zip">Zip code<sup class="required">*</sup></label> <input type="text" class="form-control" id="zip" name="zip" placeholder="What is your Zip code?" required> <div class="invalid-feedback">This field cannot be left blank</div> </div> <div class="form-group"> <label for="email">Email<sup class="required">*</sup></label> <input type="email" class="form-control" id="email" name="email" placeholder="What is your email?" required> <div class="invalid-feedback">This field cannot be left blank</div> </div> <input type="hidden" name="conditions" value=""> <div class="form-group"> <label for="condition">Condition<sup class="required">*</sup></label> <div class="form-check"> <input class="form-check-input" type="checkbox" value="conditionBladder" id="conditionBladder" name="condition"> <label class="form-check-label" for="conditionBladder"> Overactive bladder (including urgency incontinence, frequency and nocturia) </label> </div> <div class="form-check"> <input class="form-check-input" type="checkbox" value="conditionBowel" id="conditionBowel" name="condition"> <label class="form-check-label" for="conditionBowel"> Bowel (fecal) incontinence </label> </div> <div class="form-check"> <input class="form-check-input" type="checkbox" value="conditionUrinary" id="conditionUrinary" name="condition"> <label class="form-check-label" for="conditionUrinary"> Urinary retention </label> </div> <div class="form-check"> <input class="form-check-input" type="checkbox" value="conditionOther" id="conditionOther" name="condition"> <label class="form-check-label" for="conditionOther"> Other </label> </div> </div> <div class="form-group d-none" id="otherconditionnamegroup"> <label for="otherconditionname">Please specify your other condition<sup class="required">*</sup></label> <input type="text" class="form-control" id="otherconditionname" name="otherconditionname" placeholder="What is your other condition?"> <div class="invalid-feedback">This field cannot be left blank</div> </div> <div class="form-group"> <label for="description">I am a<sup class="required">*</sup></label> <select id="description" name="description" class="form-control" required> <option value="" disabled="disabled" selected="selected">Choose...</option> <option value="Patient">Patient</option> <option value="Caregiver">Caregiver</option> </select> <div class="invalid-feedback">This field cannot be left blank</div> </div> <div class="form-group"> <label for="age">Patient age<sup class="required">*</sup></label> <select id="age" name="age" class="form-control" required> <option value="" disabled="disabled" selected="selected">Choose...</option> <option value="18-24">18-24</option> <option value="25-34">25-34</option> <option value="35-49">35-49</option> <option value="50-64">50-64</option> <option value="65+">65+</option> </select> <div class="invalid-feedback">This field cannot be left blank</div> </div> <div class="form-group"> <label for="gender">Patient gender<sup class="required">*</sup></label> <select id="gender" name="gender" class="form-control" required> <option value="" disabled="disabled" selected="selected">Choose...</option> <option value="male">Male</option> <option value="female">Female</option> </select> <div class="invalid-feedback">This field cannot be left blank</div> </div> <p>Real stories without any obligation.</p> <div class="form-group"> <div class="form-check"> <input class="form-check-input" type="checkbox" value="true" id="terms" name="terms" required> <label class="form-check-label" for="terms"> By checking this box and submitting your information, you confirm that you have read and consent to <a href="/privacy-policy" target="_blank">Axonics' Privacy Policy</a> and agree to the <a href="/patients/resources-patients/connect-with-an-ambassador-terms-page"target="_blank">Patient Ambassador Program Request Terms</a>. </label> </div> </div> <input type="hidden" name="collection" value="connect"> <input type="hidden" name="forward" value="/patients/resources-patients/connect-with-an-ambassador-thank-you"> <button type="submit" class="btn btn-primary">Submit</button> </form> </div> </div> <script src="/ambassador/main.bundle.js"></script> <link rel="stylesheet" href="/ambassador/main.css" /> <div class="under-form">The Patient Ambassador program allows you to talk to someone who is a volunteer and experiencing the therapy. This person does not offer medical advice or technical support or replace conversations with your doctor. Please keep in mind that individual results will vary, so talk with your doctor about whether the therapy is right for you.</div> </div> </div><div class="container" style="margin-top: 5rem;"> <h2 style="text-align: center;">Take The Quiz. 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