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I grant permission to Peachtree Surgical and Bariatrics and or any of its facilities, to receive, take, and release my likenesses, my age, first name, date of service with Peachtree Surgical and Bariatrics, procedure completed on my person, personal weight and weight loss details, my personal insight, photography, digital, electronic, video, or other products. I understand that my characteristics, comments and images will be featured on the Peachtree Surgical and Bariatric website, and may be used on the Peachtree Surgical and Bariatrics facebook page, for press releases, promotional events , advertising purposes and distributed through the mail and via the internet, featured on the Peachtree Surgical website, and available in the office in a printed format for patient perusal. I hereby release, discharge, and hold harmless Peachtree Surgical and Bariatrics and/or its facilities from any and all claims, demands, or causes of action that I may hereafter have by reason of anything contained in these photographs or recordings. I hereby waive any right I have to inspect and/or approve the finished work and recognize changes may be made to the content to assure appropriateness. I agree to no royalties now or in the future. I do further certify that I am either of legal age, or possess full legal capacity to execute the foregoing authorization and release. I have read this release before clicking “Submit” below, and fully understand the conditions of this release.