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Terms & Conditions

PURPOSE OF AUTHORIZATION

I hereby authorize CNY Fertility to copy, exhibit, publish and distribute my client testimonial for marketing and other lawful purposes, including but not limited to posting my client testimonial on the CNY Fertility website and its social media pages, and in printed advertisements and promotions. I agree that I am voluntarily shar-ing my testimonial about services from CNY Fertility, and will not make any monetary or other claim against CNY Fertility for use of my testimonial (including my protected health information contained in the testimoni-al) for marketing purposes.

Right to Revoke

I understand that I have the right to revoke this authorization at any time by providing a written request to the Privacy Officer at CNY Fertility. I understand that if I choose to revoke this authorization, it will become effec-tive on the day the written revocation is received by CNY Fertility. Any prior uses and disclosures of my testi-monial with my protected health information will not be subject to the revocation of the authorization; how-ever, I understand that CNY Fertility will make it best effort to remove my testimonial and protected health information from the CNY Fertility’s website and its social media pages.

Components of my Testimonial

I understand that the client testimonial for CNY Fertility will only include my name, location, photograph, and information provided to the organization in my testimonial. I understand that all other protected health in-formation that CNY Fertility creates and maintains for purposes of my care will not be used in my testimonial or for marketing purposes without prior authorization per privacy regulations of the state and Health Insur-ance Portability and Accountability Act (HIPAA).

I agree and acknowledge that I have read and understood all of the elements of this authorization for use of my client testimonial.