I understand this authorization will expire, without my revocation, one year from this date of signing, or if I am a
minor on the date; I become an adult according to the state law. I understand that I may revoke this authorization
or to my insurance company. I understand that any discourse and the information may not be protected by the
federal Confidentiality rules. I accept full financial responsibility of any copying or shipping fees and any applicable
sales tax that may be charged.