iThrive Client Success & Research Release Form

Our Vision

"Our vision is to create healthier, happier, lifestyle-disease-free communities across the world every single day, and that is all we strive to do. Having said that, your success story is an inspiration for everyone, and it would be our pleasure if you give us consent to use your story."

Client Name

Date

Please review the options below and indicate your consent by checking YES or NO for each category.

Part 1: Scientific & Academic Research (CARE Guidelines)

We aim to publish your case study in peer-reviewed medical journals to help other practitioners understand our healing protocols.

- Strict anonymity is maintained (no name, no face).

- Data used: Clinical history, lab report trends, and treatment timeline.

Do you grant consent for your de-identified data to be used in scientific journals and research papers?

Yes

No

Part 2: Community Inspiration (Social Media)

We would love to share your story on our public platforms to inspire others to begin their healing journey.

1. Posts or Stories on Instagram, LinkedIn, or Facebook:

May we share your success story, testimonials, or progress on our social media channels?

Yes

No

2. Campaigns and Social Media Initiatives:

May we use your story as part of broader health campaigns to raise awareness about lifestyle diseases?

Yes

No

Part 3: Privacy & Identity Preferences

If you selected YES to Part 2 (Social Media), please choose how you would like to be identified.

Please select ONE option:

Option A: Fully Identifiable. I am proud of my journey! You may use my real first name and photos/videos of me.

Option B: Visual Anonymity. You may use my first name, but DO NOT use my photos (or blur my face).

Option C: Strict Anonymity. You may share my story, but DO NOT disclose my name (use a pseudonym) and DO NOT use my photos.

Part 4: Sign-Off

I understand that I can waive off this consent at any time before publication by contacting iThrive. However, once a story is posted or a paper is published, it may not be possible to fully retract it.

Client Signature

Signature