AestETHICS - Share your experience

SHARE YOUR PERSONAL EXPERIENCE

As part of the AestETHICS project, which continues to explore and foster dialogue on ethics in aesthetic medicine, we would like to hear your voice. We kindly ask you for a brief contribution by sharing with us your view on what working ethically in aesthetic medicine means or by describing a real case in which you had to make an ethical decision in your clinical practice.
Your perspective will be valuable in enriching the international dialogue promoted by IBSA Derma and will help contribute towards a more conscious, patient-centered approach to aesthetic medicine. Thank you in advance for your willingness to participate.
Your experience may also be published across IBSA Derma’s global communication channels and materials.

I declare that I have read and understood the

TESTIMONIAL RELEASE AND WAIVER FORM

The undersigned, a duly licensed physician, with reference to the collection of professional testimonials and experiences carried out by Ibsa Farmaceutici Italia Srl (hereinafter, “IBSA”) within the framework of the “AestETHICS” Campaign (hereinafter, the “PROJECT”),

HEREBY IRREVOCABLY AUTHORIZES

free of charge, also pursuant to and for the purposes of Article 10 of the Italian Civil Code and Articles 96 and 97 of Law No. 633 of 22 April 1941 (Italian Copyright Law), the collection, processing, publication and/or dissemination by any means of his/her professional testimonials and experiences provided within the scope of the PROJECT, in the form of textual content, as well as their storage in IBSA’s archives for a period not exceeding 2 years from registration on the dedicated website, except where longer retention periods are required by applicable law.

ACKNOWLEDGES AND ACCEPTS

that the professional testimonials and experiences may be used in any format, version or adaptation, including the modification of details thereof and/or in combination with other informational material, provided that the substantive meaning of the content provided is not altered;
that the professional testimonials and experiences may be used, by way of example and without limitation, for the following specific purposes of the PROJECT: presentations during congresses and/or training courses (in person or remotely), creation and dissemination of promotional campaigns (including via social media, websites and corporate intranet), creation and dissemination of educational and informational material, creation and dissemination of educational and promotional videos;
that once published, the testimonials may also be accessed or used by third parties not authorized by the undersigned or by IBSA.

DECLARES AND AGREES

to provide the professional testimonials and experiences in the capacity of a qualified healthcare professional and to be fully responsible for the truthfulness and accuracy of the content provided;
to waive and release IBSA from any and all claims, demands, actions or causes of action, whether pecuniary or non-pecuniary, arising out of or in connection with the use of the aforesaid testimonials by IBSA and/or by third parties;
to have no claim against IBSA for any disadvantage, loss and/or damage caused to his/her name and/or person arising from the prejudicial use of the testimonials by unauthorized third parties.

SHARE YOUR PERSONAL EXPERIENCE

Thank you for sending us your contribution!

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