Leave a Review Posted on February 19, 2024 by Eastern Oklahoma Ear Nose and Throat - Yale Office Patient Testimonial We value and appreciate your feedback. Please share your thoughts about your experience at Eastern Oklahoma ENT.AUTHORIZATION AND RELEASE INFORMATION I understand my testimonial as outlined above (the “Testimonial”) and made on behalf of Eastern Oklahoma ENT (referred to as “The Clinic”) may be used in connection with publicizing and promoting the “Clinic.” I authorize the Clinic to use my initials (full name will never be disclosed), brief biographical information and the Testimonial as defined on this form. I authorize the Clinic to photograph and interview me for the purposes of promoting their audiology services. I understand my name and identity may be used for internal and external marketing purposes, as they relate to my involvement with the Clinic. I hereby authorize the Clinic to copy, exhibit, publish or distribute the Testimonial for purposes of publicizing the Clinic’s programs or for any other lawful purpose. These statements may be used in printed publications, multimedia presentations, on websites or in any other distribution media. I agree that I will make no monetary or other claim against the Clinic for the use of the statement. I authorize Eastern Oklahoma ENT to send me educational and/or marketing information on new products or services that may become available. I further agree that my participation in any website and/or printed media produced by Eastern Oklahoma ENT confers upon me no rights of ownership whatsoever. I release Eastern Oklahoma ENT, its contractors and its employees from liability for any claims by me or any third party in connection with my participation.Consent I have read the authorization and release information. I give my consent for the use as indicated above.Printed NameEmail Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneDate MM slash DD slash YYYY Signature(Required)Thank you! We appreciate the opportunity to be of assistance to you and your family.