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I hereby authorize my testimonial to be used for testimonial advertisement in Michigan Spine & Brain Surgeons, PLLC’s promotional material, including Michigan Spine & Brain Surgeons, PLLC’s website, brochures, and advertisements. I waive the right of prior approval and hereby release and discharge Michigan Spine & Brain Surgeons, PLLC and all persons acting under the permission and authority of Michigan Spine & Brain Surgeons, PLLC from liability, damages, compensation or actions of any kind based on the use of my testimonial or information in the testimonial.
By signing below, I agree and acknowledge that I have read and understood the above Release and agree to all terms described. I am of legal age and freely sign this consent to release my patient testimonial.
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