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Testimonial release form

Testimonial release form 2026

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The document is a Client/Patient Testimonial Release Consent form from Aurora Therapeutics, Inc. and Sarasota Healing Arts, Inc. It grants permission for the use and distribution of testimonials and related information for public relations purposes, including advertising and promotions. The signer acknowledges they will not receive compensation and can revoke the consent at any time, while also ensuring that no private health information will be disclosed. The form includes options for how the individual wishes to be identified in their testimonial.

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Click ‘Get Form’ to open the testimonial release form in the editor.
Begin by reading the purpose of consent carefully. This section outlines how your testimonial will be used, so ensure you understand it fully.
In the section labeled 'I ask that:', select one of the options regarding how you wish to be identified. You can choose to be identified by your full name, first name and last initial, or remain anonymous.
Next, provide your signature and date at the designated fields. This confirms your consent for Aurora Therapeutics, Inc. to use your testimonial.
Fill in your printed name, address, phone number, and email in the respective fields to complete your contact information.

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