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I hereby authorize my testimonial to be used for testimonial advertisement in James C. Ballard, MD’s promotional material, including James C. Ballard, MD’s website, brochures, and advertisements. I waive the right of prior approval and hereby release and discharge James C. Ballard, MD and all persons acting under the permission and authority of James C. Ballard, MD from liability, damages, compensation or actions of any kind based on the use of my testimonial or information in the testimonial.

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