Patient Testimonial Release

Thank you for choosing Wilmington Eye for your vision care! If you would like to share a testimonial of your experience, please read, fill out and submit the below information. Thank you!

-The Physicians and Staff of Wilmington Eye

I hereby grant Wilmington Eye to use my testimonial in any and all of its publications, including website entries, without payment or any other consideration.

I understand that Wilmington Eye shall be the owner of the copyright of my testimonials and is entitled to reproduce it, and/or to use the testimonial in any manner.

I release Wilmington Eye from all claims, demands, and causes of action that I have or may have by reason of this authorization.

I am at least 18 years of age and have read this release before signing below and I fully understand the contents, meaning, and impact of this release.

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* Physician Name
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