Upload Form | Balance Medical

WELCOME BALANCE BABY!

Upload File

I give Balance Medical permission to publish my baby’s photo and information submitted on this form on the Balance Medical website and social media (Facebook & Instagram). I understand that this authorization is voluntary. My child’s healthcare and the payment for this healthcare will not be affected if I do not sign this form. I understand that once published, this Information may be accessed, reproduced or downloaded by anyone with access to the Internet. As a result, I understand that Balance Medical cannot control or prevent the use of this Information by others. I herby release Balance Medical, its appropriation, use, misuse, reproduction or downloading of the Information by Internet users who access Balance Medicals website or social media. This authorization will expire one year from my baby’s date of birth. I can ask Balance Medical to remove the information from Balance Medical’s website and/or social media by contacting Balance Medical’s Marketing Team at marketing@balancend.com. I understand that if I revoke this authorization, my revocation will not affect actions taken by Balance Medical prior to receiving my revocation

Signature required.

If you have any questions, please contact Balance Medical Marketing:

Balance Medical Marketing

1500 E Interchange Ave, Suite 201

Bismarck, ND 58501

marketing@balancend.com

Congratulations on your new arrival! Please allow 1-2 business days for your photo to be posted.

Balance SKIN

701-498-3991