By agreeing to this form, you authorize Al Salam Hospital Company to use and disclose your video, audio, or written testimonial for use in marketing purposes and public relations efforts and acknowledge that the testimonial may be distributed to the media and others and to individuals and entities that may participate in the efforts of Al Salam Hospital Company for Marketing and Public Relations.
Right to revoke: You have the right to revoke this permission at any time by sending a written notice and submitting it to the Marketing and Public Relations Department of Al-Salam Hospital Company. Please understand that canceling this issue will not affect any action that Al Salam Hospital Company takes before receiving the cancellation.
I hereby authorize Al Salam Hospital Company to copy, display, publish, distribute or use the video testimonial or audio or written testimonial and any information in the testimonial for the purposes of advertising for the services of Al Salam Hospital Company and for any marketing efforts or not for any other legal purpose. The data may be used in print publications, multimedia presentations, on websites, or on any other site.
I understand and agree that Al Salam Hospital Company shall publish testimonial information to the media, the public, individuals and other entities that may participate in the marketing and public relations efforts of Al Salam Hospital Company.
I agree that I will not file any financial or other claim against Al Salam Hospital Company for the use of this testimonial. I waive my pre-approval right to use my testimonial without any liability to Al-Salam Hospital Company. Damage claims of any kind based on the use of my video testimony or the information provided in the video testimonial. I understand that health information disclosed once disclosed may be re-disclosed by the beneficiary, and such re-disclosure may not be protected by law.
I understand that consent to this declaration is voluntary. I am eligible to agreeing in my name, and I have read what was stated in it before agreeing below, and I understand the complete contents of this declaration, its meaning and its impact.