Logo

OmniGuide Surgeon Locator Release Agreement

Page 1 Form
By registering for the OmniGuide Surgeon Locator program (“Program”), you grant OmniGuide, Inc. the right to publicly disclose and use your name to patients who want to connect with a surgeon to determine if treatment with the BeamPath CO2 laser system is appropriate for them. You release OmniGuide from any and all liability that may arise from the rights granted in this Release Agreement.

Please note that once your name is listed on our site, it will remain there indefinitely unless you request it be removed. Your name will be listed under the one state you select, likely your primary operating location. Names are listed in alphabetical order by last name.

 Required Question
 Required Question
 Required Question
 Required Question
 Required Question
 Required Question
 Required Question
 Required Question