Thank you for agreeing to take part in this video recording request from Empire Eye and Laser Center.

‍Transcripts will be made from the video recordings, and along with the recordings, this forms the Content. Content may be reproduced and shared by Empire Eye and Laser Center and Empire Eye and Laser Center Affilicates, for uses that may include, but are not limited to, advertising, promotion, education, and marketing on social media, websites, and all other media.

By clicking the Terms & Conditions checkbox, you are acknowledging the intended uses (above) and giving your consent for the Content to be shared without limitation. You understand that you may or may not be identified by name and that the Content will make your identity recognizable. You grant this consent as a voluntary contribution and understand that such Content shall become the property of Empire Eye and Laser Center. You release Empire Eye and Laser Center and all Empire Eye and Laser Center Affiliates and employees from any and all liability associated with the use of this Content and release and discharge all aforementioned parties from all rights that you may have in the Content, including any claim for payment in connection with its distribution or publication.

You understand that the Content disclosed, or some portion thereof may be protected by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). You further understand that, because Empire Eye and Laser Center is not receiving the Content in the capacity of a health care provider or health plan covered by HIPAA, the Content may be redisclosed and may no longer be protected by HIPAA.

You consent to Empire Eye and Laser Center collecting your video response/s and understand that they may be used in accordance with the above.