• Social media video and photographs authorization and release 

    Dana Zeitler PA-C and Mitchell Zeitler MD D-Lux Medspa
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    I hereby irrevocably consent to and authorize the use and reproduction by Dlux Medspa and its affiliates, or anyone authorized by them, of any and all photographs, electronic images or video footage taken of me by Dlux Medspa, or that Dlux Medspa has in its possession, provided either by me or by a third party (collectively , images) for the purpose of informing the medical profession and the general public about plastic surgery and plastic surgery procedures and techniques without compensation to me. Such shall include, but not be limited to, distributing the images via print, visual and electronic media specifically including the Dlux Medspa website and public social media sites such as Instagram, RealSelf, YouTube, Facebook and Twitter. The images shall be the sole property of Dlux Medspa. Dluxmedspa also shall have the right to use my name and/or demographics in connection therewith. I hereby waive any right to inspect or approve the finished product, photograph, video, DVD, CD-ROM or matter that maybe used in conjunction therewith or to the eventual use that it might be applied.  I hereby release, discharge and agree to hold harmless Dlux Medspa and its affiliates and their respective representatives, assigns, and any person acting under their permission or authority, from and against any claims whatsoever in connection with the use of my images and name and reproduction thereof as stated above, including any claims for payment in connection with distribution or publication of the video and/or photographs. I understand that any audio/ video/ photographic post made on the Internet maybe reproduced and irretrievable. I hereby warrant that I am over 21 years of age, and competent to contract in my own name insofar as the above is concerned. I have read and understand the foregoing release, authorization and agreement, and before signing my name below, and enter into it knowingly and voluntarily.

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