I hereby release and hold harmless Professional Physical Therapy & Training LLC. from any reasonable expectation of privacy or confidentialitly associated with the above photograph and/or testimonial.
I further acknowledge that my participation is voluntary and I will not receive financial compensation of any kind associated with the taking or publication of these photographs and/or testimonials or participation in Professional Physical Therapy & Training LLC. marketing materials or other publications. I acknowledge and agree that publication of said photograph and/or testimonials confers no rights of ownership or royalities whatsoever.
I hereby release Professional Physical Therapy & Training LLC. its contractors, its employees and any third parties involved in the creation or publication of marketing materials, of liability of claims by me or any third party in my connection in participation.
By signing below I hereby consent to the above and allow Professional Physical Therapy and Training, LLC to use and disclose my health information for purposes of treating me, obtaining payment for services rendered to me, and conducting healthcare operations.