Testimonial Consent

TESTIMONIAL RELEASE CONSENT

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You hereby irrevocably authorize Melissa Mol-Pelton PA-C to copy, exhibit, publish, or distribute your testimonial for the purpose of publicizing Melissa Mol-Pelton and Equestrian Orthopedic Solutions for services or for any other lawful purpose.

Your testimonial may be used in printed publications, multimedia presentations, on websites, or any other distribution media.

You also authorize Melissa Mol-Pelton and Equestrian Orthopedic Solutions to use your name and/or biographical information along with your testimonial and waive any right to inspect or approve the finished product, including any text or video wherein your testimonial appears.

You agree that you will not make any monetary or other claims against Melissa Mol-Pelton of Equestrian Orthopedic Solutions for the use of your testimonial, and hereby release Melissa Mol-Pelton and Equestrian Orthopedic Solutions from all claims, demands, and causes of action which you, your heirs, representatives, executors, administrators, or any other persons acting on your behalf have or may have by reason of this authorization. Individual results may vary.  testimonals reflect individual experiences and do not guarantee outcomes.