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We'd love to hear about your experience at Revitalis MD. Your feedback helps us serve our patients better.

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I consent to the use of my name, photograph, likeness, video, audio recording, and written or verbal testimonial for marketing, advertising, and promotional purposes. I understand that my statement may be edited for clarity and brevity while preserving the original meaning and intent. This consent is given voluntarily and I will not receive compensation.

I have read and agree to the above consent. I authorize Revitalis MD to use my name, photograph, likeness, and testimonial for marketing purposes, and I understand they reserve the right to edit my statement for clarity and brevity.