For the intangible value gained from participation in the improvement of health care technology and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, I (or a third party authorized to act on my behalf) (“Participant”) hereby grant to Modernizing Medicine, Inc., a Florida for-profit corporation, and its affiliates, subsidiaries, licensees, agents, successors, designees, and assigns (collectively, “Company”) the right to use Participant’s name, likeness, voice, conversation, sounds, and/or material (collectively, my “Appearance”) as follows:

1. Participant agrees that Company shall have the right to create and capture audio-only works, including recordings of and from Participant’s Appearance and interactions with healthcare providers and/or patients (the “Content”) by any method of recording without further consent from or any royalty, payment, or other compensation to Participant.

2. Participant acknowledges and agrees that for each health care visit between Participant and a health care provider and/or patient (each visit, a “Provider Interaction”), the Content includes: (a) an audio recording of the Provider Interaction, with such audio recording to be retained by Company for a period not to exceed six months, (b) a transcript of such audio recording, with such transcript to be retained by Company for a period not to exceed six months, and (c) a modified transcript of the audio recording that has been processed using third-party technology and/or tools designed to remove content from the transcript that would identify the patient, health care provider, and/or Participant. Company will retain such modified transcript for as long as the Company so chooses.

3. Participant agrees that Company shall forever own all rights, including copyright, in the Content and the results and proceeds of such Content, and shall have the irrevocable right to use, and license others to use, the Content in whole or in part, an unlimited number of times, in all languages, in all media whether now known or hereafter devised, anywhere in the universe in connection with the development and improvement of Company technology that may be used to help improve clinical documentation and physician practice management, including without limitation, distribution of the Content to any and all persons present at a Provider Interaction, anyone employed by or affiliated with Company who listens to the recording of the Provider Interaction after it is recorded or reviews a transcript of the recording, and anyone the Company may hire or contract with to capture, transcribe, edit or de-identify the recording or assist in the development of the Company products. Company shall have the right to edit the Content in any manner or form. Participant hereby waives any right of inspection or approval of Participant’s Appearance, including any Content related to Participant’s Appearance.

4. Participant hereby releases, discharges, and holds harmless Company from all claims, demands, or causes of action that Participant may have or receive from a third party, including without limitation, claims based upon defamation, invasion of privacy, rights of publicity, commercial disparagement, or any other claims arising from the creation of or use of the Content or Participant’s Appearance.

5. Company is not obligated to actually use Participant’s Appearance or the Content.

6. This Appearance Release shall be governed by the laws of the State of Florida (excluding its conflicts of law principles), regardless of the place of its physical execution and shall be binding on me and my successors, parents, licensees, legal representatives, heirs, and assigns (as applicable). Participant hereby submits to the jurisdiction of the state and federal courts of Palm Beach County, Florida, to resolve any dispute arising out of or resulting from this Appearance Release. Participant shall not raise, and hereby waives, any defenses based upon improper venue, inconvenience of the forum, lack of personal jurisdiction, or the sufficiency of service of process. Termination of this Appearance Release, for any reason, shall not affect Company’s rights in the Content. Company may assign its rights in the Content, in whole or in part, to any individual or entity, without restriction.

7. This Appearance Release represents the entire understanding and supersedes all prior understandings between the parties relating to the subject matter herein.