I, the undersigned patient, authorize Valor Horses for Heroes, PLLC (“Valor Horses”) and its directors and staff to use my
written testimonial for advertising and marketing purposes. I agree that this testimonial can be copied, circulated,
published, and distributed by means of various media, including printed marketing materials, on television, online,
including on Valor Horses’ website and social media pages, and in emailed marketing materials, and can be read aloud
for recorded advertising media.
I understand that the information provided in my testimonial, which I authorize Valor Horses to disclose, may include or
reflect protected information about myself held by Valor Horses, including private health information in my medical
records, the confidentiality of which may be protected by federal and state statutes and regulations. I hereby release
Valor Horses from any and all claims for damages of any kind based on the use, in accordance with this Patient
Testimonial Authorization and Release, of my testimonial or information in the testimonial.
I understand that I have the right to revoke my authorization at any time by providing a written revocation to Valor
Horses at the address above. I further understand that such a revocation will not affect any action that Valor Horses
took in reliance on my authorization prior to receiving my revocation.
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