CLIENT CONSENT FORM

We understand that we have certain rights to privacy regarding our branded product information. These rights are given to us under the Confidentiality Agreement between Us and Specialities. We understand that by signing this consent we authorize Specialities to use and disclose our protected product information to carry out:

• Development& Innovation (including direct or indirect means) by other expertise providers involved in the course of problem solving.
• Obtaining advice from third party (ies) involved (e.g. Process or filling packaging equipment provider or ingredient suppliers etc.).
• The day-to-day operations of Specialities practice.

We have also been informed of, and given the right to review and secure a copy of your Notice of Privacy Practices, which contains a more complete description of the uses and disclosures of our protected product information, and my rights under Confidentiality Agreement. We understand that Specialities reserve the right to change the terms of this notice from time to time and that we may contact Specialities at any time to obtain the most current copy of this notice.

We understand that we have the right to request restrictions on how my protected product information is used and disclosed to carry out development, innovation, and operations, but that Specialities are not required to agree to these requested restrictions. However, if Specialities do agree, Specialities is then bound to comply with this restriction.
I understand that we may revoke this consent, in writing, at any time. However, any use or disclosure that occurred prior to the date we revoke this consent is not affected.


Best Regards