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  • I hereby authorize my testimonial to be used for testimonial advertisement in Summit Healthcare Pain Clinic Associates’s promotional material, including Summit Healthcare Pain Clinic Associates’s website, brochures, and advertisements. I waive the right of prior approval and hereby release and discharge Summit Healthcare Pain Clinic Associates and all persons acting under the permission and authority of Summit Healthcare Pain Clinic Associates from liability, damages, compensation or actions of any kind based on the use of my testimonial or information in the testimonial.

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