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AUTHORIZATION FOR RELEASE OF INFORMATION

I authorize RLC Labs, Inc. to disclose and deliver to, through any and all means, including through RLC Labs internet sites (rlclabs.com, wrlonline.com, nature-throid.com, wes-throid.com): (i) potential consumers of its products, (ii) health professionals that may distribute or prescribe its products, or (iii) or any other third parties the following information related to me:

  1. Doctors Name (or Clinic Name)
  2. Address
  3. Phone Number

I understand that I have a right to inspect the disclosed information at any time. This authorization is effective until revoked by giving written notice to RLC Labs. I also understand that if I revoke this Authorization, the revocation will take effect on the day it is received in writing by RLC Labs.

RLC Labs agrees not sell any information provided by you pursuant to this Authorization.

  I SPECIFICALLY AUTHORIZE AND CONSENT TO ANY SAID DISCLOSURE DESCRIBED ABOVE.

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