I Disclaimer and Indemnity

Note: this needs to appear on all of my social media accounts. Can be small print, but it has to be there. Angie, I think it also needs to appear at the beginning or end of the course…

All content shared by Dr. Rachel Wellner, including but not limited to that published under Dr. Wellner’s Breast Wellness and Dr. Wellner’s Wellness across social media platforms, websites, or other media, is intended strictly for educational, informational, and general support purposes.

This content does not constitute medical advice and is not a substitute for individualized care from a licensed healthcare provider. No doctor-patient relationship is established through viewing, commenting on, or sharing this content.

By accessing or engaging with any material produced under Dr. Wellner’s brands, you agree that Dr. Rachel Wellner, Dr. Wellner’s Breast Wellness, and Dr. Wellner’s Wellness shall not be held liable for any direct, indirect, incidental, or consequential harm, loss, or injury resulting from your reliance on the information provided.

Viewers and followers are strongly encouraged to consult with their own physician or qualified healthcare provider before making any medical decisions or taking action based on content from these platforms.

You further agree to indemnify and hold harmless Dr. Rachel Wellner, her employees, representatives, affiliates, and associated entities (including Dr. Wellner’s Breast Wellness and Dr. Wellner’s Wellness) from any and all claims, damages, liabilities, costs, or expenses — including reasonable legal fees — arising from your use of or reliance on this content.

II Patient privacy 

Can you guys help me turn this into a Docusign? In some areas, I’m a technophobe, and I habe not idea how to do it! I think that I will have them sign and keep their records. We don’t want someone losing their job of life insurance b/c they appeared on my social media and then get sued…

Absolutely. Below is a HIPAA-compliant media release form for patients who agree to share their personal health stories on your social media platforms. It makes clear their voluntary participation, waiver of liability, and acknowledgment of HIPAA considerations.

HIPAA Authorization & Media Release Form
For Participation in Social Media Content

Patient Name: 
Date of Birth: 
Date: 

I, the undersigned, hereby authorize Dr. Rachel Wellner, Dr. Wellner’s Breast Wellness, and Dr. Wellner’s Wellness(collectively referred to as “Dr. Wellner’s Wellness Entities”) to use my personal health information, including my image, voice, name, likeness, and personal medical story for the purpose of educational, supportive, and informational content on social media, websites, and other media platforms.

I understand and agree to the following:

1. Voluntary Participation
   My participation in any interviews, video recordings, photography, or sharing of my health story is completely voluntary. I understand I may decline to answer any questions or stop participation at any time.
2. Nature of the Content
   I understand that the content created may be posted on public platforms, including but not limited to Instagram, YouTube, TikTok, Facebook, and websites affiliated with Dr. Wellner’s Wellness Entities.
3. HIPAA Authorization
   I acknowledge that by signing this release, I am authorizing disclosure of protected health information (PHI) under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). I understand that once this information is disclosed publicly, it may not be protected by federal privacy regulations.
4. No Compensation
   I understand that I will not receive any monetary or other compensation for my participation or for the use of my story, image, or likeness.
5. No Medical Advice or Treatment
   I understand that any information shared in these materials is not a substitute for professional medical care and does not establish a doctor-patient relationship.
6. Liability Waiver
   I hereby release and hold harmless Dr. Rachel Wellner, Dr. Wellner’s Breast Wellness, and Dr. Wellner’s Wellness, including their affiliates, employees, and representatives, from any and all claims, demands, damages, or causes of action, including those arising from any real or perceived adverse outcomes resulting from the public sharing of my story.
7. Revocation
   I understand that I may revoke this authorization at any time in writing, except to the extent that action has already been taken in reliance on it. I understand that once my information is posted online, revocation cannot remove it from all platforms or public domains.

Signature of Patient or Legal Guardian:
Print Name: 
Relationship to Patient (if applicable): 
Date: 

III Permission for a guest to appear on social media for Dr. Wellner’s Breast Wellness/Dr. Wellner’s Wellness

Same thing with the docusign

Guest Appearance Release Agreement
For Participation in Social Media Content

This agreement is made between the undersigned individual (“Guest”) and Dr. Rachel Wellner, including her affiliated brands Dr. Wellner’s Wellness and Dr. Wellner’s Breast Wellness (“Host Entities”).

By signing below, the Guest agrees to the following terms regarding their voluntary participation in social media content, interviews, videos, or other public media produced by the Host Entities:

1. Voluntary Participation
   I understand that my participation is entirely voluntary, and I agree to appear as a guest to share insights, expertise, or opinions on health, wellness, or related topics.
2. Media Usage Consent
   I give full permission for Dr. Rachel Wellner and her brands to record, use, edit, reproduce, and distribute my appearance, name, image, voice, and statements across all media formats including (but not limited to) Instagram, YouTube, TikTok, Facebook, websites, podcasts, and other promotional or educational platforms.
3. No Compensation
   I understand and agree that I will not receive any compensation (financial or otherwise) for my participation or for the use of the resulting content now or in the future.
4. No Liability
   I hereby waive, release, and hold harmless Dr. Rachel Wellner, Dr. Wellner’s Wellness, Dr. Wellner’s Breast Wellness, and all affiliated individuals and entities from any and all claims, liabilities, damages, or losses that may arise from my appearance or from public reactions to my participation or statements. I understand that my opinions are my own, and I assume full responsibility for them.
5. Not Medical Advice
   I understand that my appearance is for general educational and informational purposes only and does not constitute medical advice or establish any doctor-patient relationship with viewers.
6. Grant of Rights
   I grant the Host Entities the irrevocable, worldwide, royalty-free right to use the content in perpetuity for educational, promotional, or commercial purposes, without further approval required.

Guest Name (Print): 
Signature: 
Date: 
Email or Contact (for internal use only):