Testimonials consent

To comply with GDPR, please only complete the form when you have paid your deposit/session, to avoid collecting information I do not require.

Practitioner: Nathalie Crittenden-Lopis, Your Therapy.

This release form relates to my testimonial/s provided to Nathalie Crittenden-Lopis, Your Therapy.

By signing this release form, I hereby consent to the following terms:

I agree that Nathalie Crittenden-Lopis, Your Therapy, may use, reproduce, distribute and disclose the information in my Testimonial (and/or photographic/videographic likeness) and acknowledge that my Testimonial may be distributed to the public for purposes including, but not limited, to advertising, promotions, and press coverage.

I understand that I am not entitled to compensation for use of this Testimonial (and/or photographic/videographic likeness), nor input concerning its use.

I waive any right to payment for the use of the Testimonial (and/or photographic/ videographic likeness) save for use beyond the purpose set out in Paragraph 1 of this Release.

I have the right to revoke this release at any time, by providing written notice of my revocation.

I understand and approve the disclosure of Testimonial information (and/or photographic/videographic likeness) and any information contained herein in its public relation efforts.

I waive the right of prior approval and hereby release Nathalie Crittenden-Lopis from any claims for damages of any kind, in the use of this Testimonial or information in this Testimonial (and/or photographic/videographic likeness).

This release is subject to the governing law and jurisdiction of the English Courts.

Data Protection Statement

To comply with the GDPR (General Data Protection Regulation)/applicable Data Protection Regulation, Nathalie Crittenden-Lopis, Your Therapy, needs explicit permission to process, store and use any of your personal data for marketing purposes.


. I acknowledge that this Testimonial may contain my personal data and that it will be shared with the public for marketing and other purposes set out in Paragraph 1.

. I also understand that I am entitled to access this personal data held by Nathalie Crittenden-Lopis, Your therapy, and where appropriate, make requests including for the correction or deletion of my personal data.

. By signing this form, I consent to any personal data contained in the Testimonial being shared publicly by Nathalie Crittenden-Lopis, Your Therapy, and stored in accordance with the GDPR/ applicable Data Protection Regulation.

I consent to all the above (add your initials …...............)

Therapist signature: Nathalie Crittenden-Lopis

Client signature: ...................................................

Date: …..................................