Party Photo Waiver

By attending TRM’s 10th anniversary celebration, I agree to authorize Tennessee Reproductive Medicine and its affiliates to take, edit, publish photographs taken at the event, this includes photographs of my child/children.

I understand that Tennessee Reproductive Medicine may release this information to other social media sites, to its website, and to any other company that promotes Tennessee Reproductive Medicine, including, without limitation, to any news media, all of whom may not be subject to the same federal health privacy laws.

I additionally understand that, once published or released, Tennessee Reproductive Medicine has no control over who views or uses the information. I further understand that Tennessee Reproductive Medicine cannot condition treatment or payment on whether I submit this information and that my healthcare or payment for healthcare will not be affected by my refusal.

By submitting this form, this authorization shall remain in effect for 5 years, and I understand that I can revoke the use of this information at any time by submitting a written revocation to Tennessee Reproductive Medicine, which will be effective upon receipt by Tennessee Reproductive Medicine.

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