Share Your Rebound Story

I, the undersigned, do hereby consent and agree that Rebound Orthopedics & Neurosurgery (“Rebound”) and its staff, agents, successor and assigns have the right to use and publish my Rebound Story and its related images, videos, and audio supplied or authorized by me for Rebound’s educational, promotional or publicity purposes.

I hereby agree to release to Rebound, its staff, agents, successor and assigns all rights to exhibit this work publicly or privately, including posting these images on a web site. I waive any rights, claims or interests I may have to control the use of my identity or likeness in the photographs, video, audio, or visual image, however the work is published and agree that any uses described herein may be made without compensation or additional consideration of me. Furthermore, I hereby waive any right to approve the finished work.

Revocation: This authorization is valid until I submit a revocation request and it is received by Rebound and they are provided a reasonable time to remove any content I had authorized previously.  I understand my revocation request must be submitted in writing to the Rebound Privacy Officer by submitting a revocation request to: medicalrecords@reboundmd.com