Testimonial Release

I hereby grant permission to the rights of my image, likeness, and written testimonial without payment of any other consideration. I understand that by providing my testimonial and/or image, it may be copied, exhibited, published, or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I also understand that this material may be used within an unrestricted geographic area.

Photographic, audio or video recordings may be used for the following purposes:

Social media campaigns
Website blogs
Website testimonials
Promotional marketing materials including video, print, and online

By signing this release, I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the Internet or in a public setting.

I will be consulted about the use of the photographs or video recordings for any purpose other than those listed above.

There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.

This release applies to written testimonials, photographic, audio, or video recordings collected as part of this event/appointment.

By signing this form, I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against EVEXIAS Health Solutions.

Name *

First

Last

Phone *

What is the name of the practitioner or practice development specialist that referred you to submit a testimonial *

Email *

Date of Birth *

Your Role in the Practice *

Date *