I affirm under penalty of perjury that I am a Patient and user (“Patient”) of Diamond Braces, and I provide this Patient testimonial declaration and release (“Release”) to Diamond Braces as its Patient.

I grant Diamond Braces and its licensees the perpetual right to use my full name, face, image, picture, voice, likeness, and biographical information (collectively, my “Persona”) and/or my “Orthodontic Journey” in connection with my statements and opinions about Diamond Braces and its Services (collectively, “Opinions and Statements”) for advertising and any other legal purpose, in any media, without additional consideration. I also grant Diamond Braces the right to state or imply endorsements of Diamond Braces and/or the Services using my Persona, Orthodontic Journey, Opinions, and Statements.

I affirm that my Opinions and Statements are true and accurate based on my personal experience. I am of legal age and have the right to grant these rights. I acknowledge that Diamond Braces is not obligated to use my Persona, Orthodontic Journey, Opinions, and Statements.

I release and discharge Diamond Braces and its agents from any claims arising from the use of my Persona, Orthodontic Journey, Opinions, and Statements. I agree not to sue Diamond Braces based on its use of my Persona, Orthodontic Journey, Opinions, and Statements. I waive any right to inspect or approve the use of my Persona, Orthodontic Journey, Opinions, and Statements.

This Release is binding and inures to the benefit of my heirs. I certify that I have read and understand this Release. I can revoke this authorization in writing at any time.