PATIENT TESTIMONIAL RELEASE FORM

I, ________________________________ hereby authorize Body Contour Centers, LLC d/b/a Sono Bello ("Company") and its employees, agents, partners, subsidiaries and affiliates to use and disclose my name, likeness, images, video recordings,audiorecordings, biography, statements, and endorsements of Company ("Testimonial') for marketing, advertising and sale of Company's products and services, including on Company's website, social media channels, television commercials, publications, brochures and any other owned, controlled or paid advertising media.

I understand that the use and disclosure of my Testimonial may include personal health information. I also understand that, once disclosed, any subsequent disclosures by recipients of my Testimonial may not be protected by the Health Insurance Portability and Accountability Act ("HIPAA") Privacy Rule. I also understand that my authorization for Company to use and disclose my Testimonial is not a condition to receiving treatment. I further understand this is not a SAG-AFTRA production.

I understand that I have the right to revoke this authorization at any time by providing written notice of my revocation to Chief Marketing Officer, Sono Bello at 5250 Carillon Point, Kirkland, WA 98033. I also understand that my revocation of this authorization will not affect any prior action taken by Company and its employees, agents, partners, subsidiaries and affiliates in reliance on this authorization prior to receiving my revocation.

I hereby release and hold harmless Company and its employees, agents, partners, subsidiaries and affiliates from any liability that I have or may have based on this authorization. I further warrant that I am at least 18 years of age and have the full right and legal capacity to sign this authorization. I agree and acknowledge that I have read and understood this authorization prior to signing it.

This authorization is effective on the date it is signed and will remain in effect unless and until it is revoked.

This Patient Testimonial Agreement ("Agreement") is entered into by Centers, LLC d/b/a Sono Bello ("Company") (collectively, the "Parties") and is effective on the date it is signed by all Parties ("Effective Date" The Parties agree as follows:

1. Consideration. In consideration of Patient's agreement to the terms herein, and Patient's work with Company as a SonoBello Ambassador, Company shall provide Patient a gift card or payment upon completion of Patient's work with Company in an amount determined by Company. Patient agrees that she/he has been provided the amount of the gift card or payment in an email prior to signing this Agreement and agrees the amount is fair and adequate consideration for Patient's agreement to the terms herein.

2. Non-Disparagement. During and after Patient's work with Company, Patient agrees not to make any disparaging, derogatory or untrue statements about Company or its business activities, products, services, or any of its directors, managers, officers, employees, affiliates, agents or representatives. Nothing in this Agreement prevents Patient from expressing an honest opinion about Company's products or services.

3. Confidentiality. During Patient's work with Company, Patient may come into possession of non-public, confidential or proprietary information, including but not limited to agreements, client lists, audio, video, film or other media created, maintained or usedbyCompany ("Confidential Information" Patient agrees not to use or disclose any Confidential Information received from Company during or after Patient's work with Company. Patient further agrees to, at Company's request, return or destroy all Confidential Information received from Company.

4. FTC Compliance. During Patient's work with Company, Patient acknowledges and agrees to comply with the Federal Trade Commission's Guides Concerning Use of Endorsements and Testimonials in Advertising ("Guides") and must includethetext #SonoBelloAmbassadorsimilarTheGuideslocated mutuallyagreedlanguage. ttps://www.ftc.gov/sites/default/files/attachments/press-releases/ftc-publishes-final-guides-governing-endorsements- testimonials/091005revisedendorsementguides.pdf

5. General. This Agreement (including the email containing the amount of the gift card) is the entire agreement among the Parties. The provisions of this Agreement are severable. If any provision of this Agreement is held invalid, the invalidity shall not affect other obligations, provisions, or applications of this Agreement. This Agreement will be governed by the laws of the State of Washington without regard to conflict of law principles. The parties hereby consent to the exclusive jurisdiction and venue of the state and federal courts sitting in King County, Washington for all matters and actions arising under or relating to this Agreement. Company's liability under this Agreement, if any, is limited to the value of Consideration. This Agreement may be signed in counterparts, including by electronic signature, each of which will be deemed original and together constitute one single agreement.

IN WITNESS WHEREOF, the Parties have duly executed this Agreement as of the Effective Date.

Body Contour Centers, LLC d/b/a Sono Bello