Share Your Story Waiver

By submitting my personal story or agreeing to be interviewed, I understand that CU Rocky Mountain OB-GYN may publish this information to other social media sites, to its website, and to any other company that promotes CU Rocky Mountain OB-GYN, 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, CU Rocky Mountain OB-GYN has no control over who views or uses the information. I further understand that CU Rocky Mountain OB-GYN 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 for 5 years, and I understand that I can revoke the use of this information at any time by submitting a written revocation to CU Rocky Mountain OB-GYN, which will be effective upon receipt by CU Rocky Mountain OB-GYN.