Testimonial Consent, Release & Restore Holistic Wellness

1 Your information

A few basics.

Full name *

Email *

Today’s date *

2 Your testimonial

Your words, exactly as you want them shared.

Below is the testimonial you’re consenting to share. If anything feels off, edit it now, only the version you sign off on will be used.

3 How you’d like to be identified

Choose how your name appears.

Full name e.g. “Sarah Mitchell” First name + initial e.g. “Sarah M.” Anonymous No name shown

4 Where it may appear

Pick all the places you’re comfortable with.

Select any combination. You can revoke this consent in writing at any time.

Website Social media Marketing emails Printed materials Google Business listing

5 Photo & video

Are you also consenting to use of your photo or video?

No, words only Just the testimonial text. No photo or video. Yes, photo / video okay I’ll provide or have provided a photo / video for use.

6 Final acknowledgments

Please confirm.

Check each item. All are required.

I am providing this testimonial voluntarily. I have not been paid, pressured, or compensated in exchange for this consent. * The words above are my own and reflect my honest experience. * I understand my experience is personal and that results vary from person to person. * I understand I can revoke this consent at any time by emailing bryan@releaseandrestorewellness.com. Revocation will stop new uses going forward; any printed materials already produced will be retired in their next reprint. * My testimonial does not claim that this work cured, treated, or diagnosed any medical or psychological condition. *

7 Signature

Type your full name as your signature.

By typing your name below, you confirm everything above.

Your signature must match the full name in Section 1.

Sharing your story, on your terms.

Thank you.