180 Medical Consent and Release Form

I hereby authorize 180 Medical to use and/or share the information submitted, including my written statements, photographs, videos, sound recordings, or testimonial in whole or in part, in all forms of media now known or later developed for advertising, trade, and any other lawful purposes.

I understand I will not receive compensation for sharing my story or experience with 180 Medical and have no right to view or approve the materials before or after publication.

Consent & Release Form

Full Name*
If you are a parent or legal guardian signing on behalf of a minor, please enter the minor's first and last name here. Then e-sign your name by typing in the next field with your own first and last name.
First Last
Email
E-Signature*
Please type your name here to e-sign this consent and release form.
Full Name

Call Toll-Free (877) 688-2729

Catheter Supplies

Ostomy Supplies