Your Testimonial

This is to certify that I have choose to give my testimonial as an ocular patient being treated by Central Markham Dental Centre/Dr. Edward Liu. I understand that by submitting my testimonial it does not guarantee the use of my testimony. I understand that by submitting my testimonial I give Central Markham Dental Centre/Dr. Edward Liu the right to use my testimonial for reproduction in any medium including but not limited to; website, video, broadcast, print, and electronic means for purposes of advertising, trade, display, exhibition or editorial use. The undersigned releases Central Markham Dental Centre/Dr. Edward Liu from all claims for libel, slander, invasion of privacy, infringement of copyright or right of publicity or any other claim. I hereby agree to have my name appear as in any posting or publication. The undersigned is an adult and fully authorized to sign this Consent and Release Form.