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David S. Levine, M.D., Board Certified Orthopedic Surgeon, Foot & Ankle Trauma and Resconstructive Surgery, New York City, White Plains & Westchester, NY

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Testimonial Release Consent

You hereby irrevocably authorize David S. Levine, M.D., Board Certified Orthopedic Surgeon, Foot & Ankle Trauma and Resconstructive Surgery, New York City, White Plains & Westchester, NY to copy, exhibit, publish, or distribute your testimonial for the purpose of publicizing David S. Levine, M.D., Board Certified Orthopedic Surgeon, Foot & Ankle Trauma and Resconstructive Surgery, New York City, White Plains & Westchester, NY services or for any other lawful purpose.

Your testimonial may be used in printed publications, multimedia presentations, on websites, or any other distribution media.

You also authorize David S. Levine, M.D., Board Certified Orthopedic Surgeon, Foot & Ankle Trauma and Resconstructive Surgery, New York City, White Plains & Westchester, NY to use your name and/or biographical information along with your testimonial and waive any right to inspect or approve the finished product, including any text or video wherein your testimonial appears.

You agree that you will not make any monetary or other claims against David S. Levine, M.D., Board Certified Orthopedic Surgeon, Foot & Ankle Trauma and Resconstructive Surgery, New York City, White Plains & Westchester, NY for the use of your testimonial, and hereby release David S. Levine, M.D., Board Certified Orthopedic Surgeon, Foot & Ankle Trauma and Resconstructive Surgery, New York City, White Plains & Westchester, NY from all claims, demands, and causes of action which you, your heirs, representatives, executors, administrators, or any other persons acting on your behalf have or may have by reason of this authorization.

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