REFERENCE & IMAGE RELEASE FORM & NON-DISCLOSURE FORM
Reference & Image Release
I hereby grant permission to Vakt, Inc to reproduce any portion of the images regarding my dental treatment or myself for the purpose of Marketing and Product Development which can include but is not limited to brochures, books, cards calendars, invitations and websites without any compensation or recognition given to me. Furthermore, I grant creative permission to alter the photograph(s). I also grant use of a written recommendation or reference developed by Vakt, Inc. using my demographic information. I do not grant permission to resale or use the photographs or the recommendation/reference in a manner that would exploit or cause malicious representation toward me. I recognize that I am being compensated for this release through a discounted rate for the product provided by Vakt, Inc. and this represents a full accounting for all compensations for this usage.
“Confidential Information” means any oral, written, graphic or machine-readable information including, but not limited to, that which relates to prices, patents, patent applications, research, product plans, products, developments, inventions, processes, designs, drawings, engineering, formulae, markets, software (including source and object code), hardware configuration, computer programs, algorithms, business plans, agreements with third parties, services, customers, marketing or finances of the disclosing party, which Confidential Information is designated in writing to be confidential or proprietary, or if given orally, is confirmed in writing as having been disclosed as confidential or proprietary within a reasonable time (not to exceed thirty (30) days) after the oral disclosure.
I agree not to use any Confidential Information disclosed for any purpose other than to carry out discussions concerning, and the undertaking of, the Orthodontic Services. I shall not disclose or permit disclosure of any Confidential Information to third parties. I agree that I shall take all reasonable measures to protect the secrecy of and avoid disclosure or use of Confidential Information in order to prevent it from falling into the public domain or the possession of persons other than those persons authorized under this Agreement to have any such information. Such measures shall include, but not be limited to, the highest degree of care that I utilize to protect my own Confidential Information of a similar nature, which shall be no less than reasonable care. I agree to notify Vakt Inc in writing of any actual or suspected misuse, misappropriation or unauthorized disclosure of Confidential Information which may come to my attention.
(a) Notwithstanding the above, I shall not have liability for any information which is in the public domain at the time it was disclosed or has entered the public domain through no fault of mine; (b) was known to me, without restriction, at the time of disclosure, as demonstrated by files in existence at the time of disclosure;
(c) is disclosed with the prior written approval of Vakt Inc; or (d) is disclosed pursuant to the order or requirement of a court, administrative agency, or other governmental body; provided, however, that I shall provide prompt notice of such court order or requirement to Vakt Inc to enable Vakt Inc to seek a protective order or otherwise prevent or restrict such disclosure.