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Release Authorization
Purpose of Authorization:
By digitally signing my name to the form, I give Global Dental Science LLC ("Producer") my full consent to use, share, distribute, or even sell my client testimonial. This could be in print, online, on podcasts, TV, or radio. My testimonial might also be used for markets unknown to me and with dentists other than my own.

Components of Testimonial:
I understand my testimonial might include my name, location, photos, videos, and the opinions I share.

Agreement to Share Testimonial/images:
I am willingly sharing my testimonial and images, which includes personal experiences that are normally private. I'm aware that once I've shared my testimonial, it might reach people or organizations not bound by privacy laws like HIPAA, meaning my information could be widely shared.

Right to Revoke:
I know I can stop my consent anytime by writing to the Producer. However, any use of my testimonial before revoking won't be affected. The Producer will try to remove my public testimonial, but there’s a chance it can't be completely retrieved.

Not a Condition of Treatment:
My decision to share my testimonial or image doesn’t affect my dental care or benefits. The Producer is separate from my dentist.

Agreement:
By digitally signing my name to the form, I confirm I've read and understood this authorization. It lasts until I decide to end it.