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I hereby authorize my testimonial to be used for testimonial advertisement in Orthopedic Specialists of San Diego Helix Orthopedics & Sports Medicine’s promotional material, including Orthopedic Specialists of San Diego Helix Orthopedics & Sports Medicine’s website, brochures, and advertisements. I waive the right of prior approval and hereby release and discharge Orthopedic Specialists of San Diego Helix Orthopedics & Sports Medicine and all persons acting under the permission and authority of Orthopedic Specialists of San Diego Helix Orthopedics & Sports Medicine from liability, damages, compensation or actions of any kind based on the use of my testimonial or information in the testimonial.

By signing below, I agree and acknowledge that I have read and understood the above Release and agree to all terms described. I am of legal age and freely sign this consent to release my patient testimonial.

Participant’s Signature: (Typing your name here indicates that all of the above information is accurate and acts as your electronic signature.)