Consent to Use and Disclose My Health Information, Photograph, Video, and Testimony
I agree to allow Nevro Corp. and its agents, affiliates, successors, and assigns (collectively, “Nevro”) to publish my photograph, name, and testimonial story, including medical and health information, about my experience with Nevro’s SENZA® Spinal Cord Stimulation System (“Nevro’s Product”) for marketing content, advertising, and other business-related purposes. By clicking below to agree to the terms of this consent form, I agree as follows:
I understand that any photographs or videos of me (“Media Images”) and/or Media Images captions, stories, or testimonials (“Testimonials”) may be used to describe my experience with Nevro’s Product.
I grant Nevro the unlimited right, to edit, publish, broadcast, display, use, and reproduce the Media Images and Testimonials, including my individually identifiable health information, either in whole or in part, whether alone or in conjunction with other matters, for business-related purposes, including but not limited to advertising, education, and training. The Media Images and Testimonials may appear in different formats and on various platforms, including but not limited to, websites, social media, television, audio, print, and video.
Once I’ve submitted my Media Images or Testimonials to Nevro, I acknowledge that I will not be able to inspect or approve the Media Images or Testimonials before they are used. I further agree that Nevro has no obligation to use any of the Media Images or Testimonials.
I certify that I am eighteen (18) years old or older and give this consent of my own free choice. I understand that I am in no way obligated to agree to these terms. If I choose not to agree or provide my Media Images or Testimonial, my access to Nevro’s Products will not be affected.
I understand that once I have agreed to these terms, I cannot change my mind and cancel it for any Media Images or Testimonials that have already been completed.
Nevro, Nevro employees, and anyone accessing Nevro’s websites, social media platforms, or promotional materials may learn about my individually identifiable health information by participating in the Media Images or Testimonials and/or by observing the Media Images or Testimonials.