Authorization For Use or Disclosure of Client Photographic and/or Video Images AUTHORIZATION: I authorize the use and disclosure of my name, photographic/video images, and/or testimonial for marketing purposes by the practice/salon listed below. I understand that information disclosed pursuant to this authorization may be subject to redisclosure and may no longer be protected by HIPAA privacy regulations. PURPOSE: The photographic/video images, and/or testimonial will be used for: Social Media and/or Advertising REVOCABILITY: I understand that I may revoke this authorization at any time, but such revocation must be in writing and received by the practice/salon via registered mail. Revocation affects disclosure moving forward and is not retroactive. This authorization expires 99 years from date signed. NO TREATMENT CONDITIONS: I understand that the practice/salon cannot condition treatment on whether or not I sign this authorization. Please ask your lash artist for a copy of this if you desire one. 24-hour notice is required for any canceled or rescheduled appointment or 50% of service price will be charged. Failure to show without notice will require in full payment of service booked. *Re-do’s at a 50% charge will only be done within 7 days of initial service. By signing below, I verify that I have read and understand the above statements, and agree to them. The Archery does not offer monetary refunds on services rendered.