Authorization and Release:
I understand my testimonial, as outlined above and any video relating thereto which may include the Testimonial Statement and other testimonial and/or information (the
"Testimonial"), made on behalf of Quest Diagnostics Incorporated and its affiliates (referred to hereinafter
as "The Company") as well as any images or video taken of me by or on behalf of The Company, may be
used in connection with publicizing and promoting The Company. I authorize The Company to use my
name, image, brief biographical information, and the Testimonial, including any individually identifiable
health information disclosed by me in the Testimonial, as defined on this form.
I hereby irrevocably authorize The Company, its employees, legal representatives or assigns, affiliates and
those acting under its permission and upon its authority (the foregoing collectively being referred to as
“Representatives”), to copy, exhibit, publish or distribute the Testimonial and my image and video for
purposes of publicizing The Company's services, products or offerings (both internally and externally to the
public) or for any other lawful purpose. The Testimonial and images may be used in printed publications,
multimedia presentations, on websites or in any other distribution media currently existing or existing in
the future. I agree that I will make no monetary or other claim against The Company or any of its
Representatives for the use of the Testimonial or any images of me.
In addition, I waive any right to inspect or approve the finished product, including written copy,
photographs or video, wherein my image and/or my Testimonial appear.
I hereby hold harmless and release The Company and its Representatives from all claims, demands and
causes of action which I, my heirs, representatives, executors, administrators or any other persons acting
on my behalf, or on behalf of my estate, have or may have by reason of this authorization, including
without limitation, claims for libel, invasion of privacy, breach of confidentiality, breach of privacy laws, as
well as any liability arising by virtue of any blurring, distortion, or alteration (whether intentional or
otherwise) that may occur or be produced in the reproduction of the Testimonial, or in the making of any
picture, video, recordings or in any other processing associated with my Testimonial.
