Blinkjoy Product Study - Consent, Media, and Contact Authorization

I, ______________________, voluntarily agree to participate in a Blinkjoy Commercial Study conducted at _________________ under the supervision of ___________________. The purpose of this study is to evaluate Blinkjoy products in real-world use. My participation is voluntary and I may withdraw at any time without affecting my care or relationship with my doctor or clinic. As part of this study, I may:

Receive Blinkjoy products free of charge for the duration of the study.
Provide before and after photos of my eyelids and periocular area.
Complete follow-up surveys or questionnaires about my experience with the product.
Be contacted by Blinkjoy Inc. and/or my clinic via email, phone, or SMS text message for follow-up communication and study updates.

I understand that completion of follow-up submissions is an expected part of my participation and helps contribute to meaningful study outcomes.

Use of Images, Testimonials, and Data

I grant permission to Blinkjoy Inc. to use my photographs, videos, testimonials, and written responses for educational, marketing, research, or publication purposes. This may include, but is not limited to, use on websites, social media, printed materials, clinical presentations, or white papers. I understand and agree that:

Images or video collected may include close-ups of my eyes and periocular region, which could be considered personally identifiable under certain privacy standards. By signing this form, I expressly consent to the use of these images for the purposes described above.
My name, contact information, or full face will NOT be used in any public materials.
All responses and data will be anonymized and aggregated with other participants’ results for analysis and reporting.
Blinkjoy and the participating clinic will store my contact information securely and use it solely for study-related follow-up and communication.
Access to any identifiable information will be limited to authorized study personnel only.

Health and Safety Disclaimer

I understand that Blinkjoy products are not intended to diagnose, treat, cure, or prevent any medical condition or disease. If I experience any discomfort, irritation, or adverse reaction, I agree to discontinue use immediately and contact my doctor or healthcare provider. I acknowledge that my participation is for observational and educational purposes only and does not constitute medical treatment or clinical therapy.

Study Nature and Compensation

I understand that this study is not a medical treatment or diagnostic program, and participation does not replace professional medical advice or care. The purpose of this study is to observe comfort, usability, and satisfaction related to product use. I may receive the study product(s) at no cost for the duration of participation. No additional financial compensation will be provided.

Consent and Acknowledgment

By signing below, I acknowledge that I have read and understood this form, had the opportunity to ask questions, and voluntarily consent to participate in this Blinkjoy Commercial Study.

Please check each box:

⃞ I consent to participate in the product evaluation

⃞ I consent to the use of my images/testimonials as outlined above

⃞ I consent to receive SMS messages sent via an autodialer from Blinkjoy Inc. regarding my participation in the Blinkjoy product study, including enrollment confirmations and study check-in reminders. Message and data rates may apply. Message frequency varies. This agreement isn't a condition of any purchase. Participation is voluntary. Text STOP to opt out anytime. Text Help for assistance.

No mobile information will be shared with third parties/affiliates for marketing/promotional purposes. All the above categories exclude text messaging originator opt-in data and consent; this information will not be shared with any third parties.

Name: _________________________________________________

Email: _________________________________________________

Phone: _________________________________________________

Signature: _________________________________________________

Blinkjoy Inc.

279 Rain Tree Drive, Encinitas, CA 92024, USA

support@blinkjoy.com | www.blinkjoy.com