I hereby authorize the use of my likeness and/or story for any and all purposes. I agree that Brighter Image Lab will not be held liable for any loss, damages of injury associated with applying for, accepting, or using their new smile. I agree that Brighter Image Lab retains the right to make any and all decisions as to the nature of the products or services being rendered and/or to cancel any agreement or work being done for any reason whatsoever. By submitting this form, I confirm I have read and agree to all of the terms & conditions.