Testimonials

I understand my testimonial as outlined on the digital  form " Testimonial Request" (hereinafter called" the Testimonial") and made on behalf of London Lang, M.S., CCC-SLP and Mindful Speech &Wellness (hereinafter called "The Practice") may be used in connection with publicizing and promoting The Practice. I authorize The Practice to use  my Testimonial  as defined on this form. I understand that my personal and health information is protected under federal and state statues and regulations; thereby, I give my release of the information stated on this form to The Practice. I hereby authorize The Practice to copy, reproduce, disclose, exhibit, publish, or distribute the Testimonial in full or in part for purposes of publicizing, advertising, promoting The Practice’s services or for any other lawful purpose. These statements may be used in printed publications, presentations, social media, websites or in any other distribution media. I agree and understand that I will make no monetary or other claim against The Practice for the use of the testimonial. In addition, I waive any right to inspect or approve the finished product, including written copy, wherein my testimonial appears. I hereby hold harmless and release The Practice from all claims, demands and causes of action which I or any other persons acting on my behalf or onbehalf of my estate have or may have by reason of this authorization. I understand that I have the right to revoke this Release at any time by giving the Practice written notice of revocation and submitting it to The Practice. Please understand that revocation of this Release will not affect any action the Practice took in reliance on this Release before receiving your revocation. I understand that submitting a testimonial is voluntary. My treatment, payment, enrollment in ahealth plan, or eligibility for benefits will not be conditioned upon this Release. I am atleast 18 years of age and am competent to contract in my own name. I have read this Release before signing above in the "name" field  and I fully understand the contents, meaning, and impact of this Release. By submitting a testimonial above, I understand the terms listed above and have read the authorization and full release information. By signing above, I give my consent for the use of my testimonial as indicated above.