Testimonials / Feedback
Your Feedback Is Important To Us
There are many ways to fail and fewer ways to succeed. We would be most grateful if you would take a few minutes to offer feedback about your experience working with us. We are especially interested in learning what we did that you found most helpful or if we did anything that you wish we did not do. please complete the release of information form below. [You will not be identified by name].
Authorization and Release Information
I understand my testimonial as outlined above (the “Testimonial”) and made on behalf of [Company Name] (hereinafter called “The Company”) may be used in connection with publicizing and promoting The Company. I authorize The Company to use my name, brief biographical information, and the Testimonial as defined on this form.
I hereby irrevocably authorize Psychological A.R.T.S., PC to copy, exhibit, publish or distribute the Testimonial for purposes of publicizing programs or for any other lawful purpose. These statements may be used in printed publications, multimedia presentations, on websites or in any other distribution media. I agree that I will make no monetary or other claim against Psychological A.R.T.S. for the use of the statement.
In addition, I waive any right to inspect or approve the finished product, including written copy, wherein my likeness or my testimonial appears.
I hereby hold harmless and release Psychological A.R.T.S. from all claims, demands and causes of action which I, my heirs, representatives, executors, administrators or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.