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I hereby consent to Good Shepherd Health System and its affiliate organizations submitting my testimonial(s) to be used for purposes of publication in Good Shepherd Health System’s advertising and public relations efforts. I understand that upon clicking “Submit”, I release and hereby agree to release and hold Good Shepherd Health System harmless from any and all liability arising out of the subsequent publication and broadcasting of the information I have submitted. I understand that my testimonial submission is being used with my consent, that such consent is being relied upon by Good Shepherd and may not be revoked, and that such consent is valid and enforceable by Good Shepherd in perpetuity.

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