By submitting my personal story or agreeing to be interviewed, I understand that Women & Infants’ Fertility Center may publish this information to other social media sites, to its website, and to any other company that promotes Women & Infants’ Fertility Center, 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, Women & Infants’ Fertility Center has no control over who views or uses the information. I further understand that Women & Infants’ Fertility Center 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. I also understand that submitting my story does not entitle me to any monetary or other compensation.
By submitting this entry, this authorization shall remain in effect until such time as I revoke the use of this information, which I can do at any time by submitting a written revocation to Women & Infants’ Fertility Center, and will be effective upon receipt by Women & Infants’ Fertility Center.