LAP-BAND® Patient Story Submission Terms and Conditions October 1, 2015

These terms and conditions are made by and between Apollo Endosurgery, Inc., with an office located in Austin, Texas (hereinafter referred to as “Apollo”), and the Patient (hereinafter referred to as “Patient”).

For good and valuable consideration, herein acknowledged as received and sufficient, and by signing this release, the PATIENT hereby grants Apollo, their heirs, legal representatives and assigns (“Assigns”), including but not limited to any person, print or online publication or website, or any advertising medium Apollo shall choose to advertise and market their product, any firm or corporation which is a subsidiary, parent or affiliate of Apollo, customer of Apollo (including but not limited to the treating physician of PATIENT) or to a successor corporation of Apollo, the irrevocable and unrestricted right and permission to copyright, in their own name or otherwise, and use, re-use, publish, and re-publish PATIENT’s first name, likeness, image, voice, appearance, performance and submitted patient experience or story, in whole or in part, as part of a composite or distorted in character or form, without restriction as to changes or alterations, or reproductions thereof in color or otherwise, in any and all media now or hereafter known for illustration, promotion, art, editorial, advertising, trade, publishing or any other purpose whatsoever (collectively, “Media”). The PATIENT also consents to the use of any printed matter in connection therewith.

The PATIENT hereby waives any right that they may have to inspect or approve the finished product or products and the advertising copy or other matter that may be used in connection therewith or the use to which it may be applied.

The PATIENT hereby releases, discharges, and agrees to hold harmless Apollo, and/or Assigns, and all persons acting under Apollo’s authority or those for whom he/she is acting, from any liability by virtue of any use of the Media or any changes or alterations made thereto.

The PATIENT agrees that they have no rights to the Media, and all rights to the Media, including the copyright, belong to Apollo and Assigns. The PATIENT acknowledges and agrees that they are providing this release freely and no further sums shall be payable to the PATIENT by Apollo by reason of the use of the Media and that the PATIENT will make no further claim, for any reason, including any claims for libel or invasion of privacy, to Apollo and Assigns.

The PATIENT acknowledges and agrees that this release shall be binding upon the PATIENT, their heirs, legal representatives and assigns. The PATIENT agrees that this release is irrevocable, worldwide and perpetual.

The PATIENT hereby warrants that he/she is of full legal age and has the right to contract in his/her own name. The PATIENT has read the above authorization, release, and agreement, prior to its execution, and is fully familiar with the contents thereof.

Find a specialist that fits you.

The key to success with the LAP-BAND® is finding the right weight loss clinic. Your team of weight loss specialists will provide you with care and encouragement throughout your weight loss journey. It’s important that you find the right weight loss clinic for you.


FIND A SPECIALIST

Find out if you are eligible.

Are you ready to make a life-long change? If you are tired of feeling self-conscious, hiding behind baggy clothing, or not feeling entirely comfortable in your own skin – chances are, you’re ready. It’s important to begin by finding out if the LAP-BAND® gastric band will be a safe choice for you.


IS IT RIGHT FOR ME?

Important LAP-BAND® System Safety Information

Indications: The LAP-BAND® System is indicated for weight reduction for patients with obesity, with a Body Mass Index (BMI) of at least 40 kg/m2 or a BMI of at least 30 kg/m2 with one or more obesity-related comorbid conditions. It is indicated for use only in adult patients who have failed more conservative weight reduction alternatives, such as supervised diet, exercise and behavior modification programs. Patients who elect to have this surgery must make the commitment to accept significant changes in their eating habits for the rest of their lives.

Contraindications: The LAP-BAND® System is not recommended for non-adult patients, patients with conditions that may make them poor surgical candidates or increase the risk of poor results (e.g., inflammatory or cardiopulmonary diseases, GI conditions, symptoms or family history of autoimmune disease, cirrhosis), who are unwilling or unable to comply with the required dietary restrictions, who have alcohol or drug addictions, or who currently are or may be pregnant.

Warnings: The LAP-BAND® System is a long-term implant. Explant and replacement surgery may be required. Patients who become pregnant or severely ill, or who require more extensive nutrition may require deflation of their bands. Anti-inflammatory agents, such as aspirin, should be used with caution and may contribute to an increased risk of band erosion.

Adverse Events: Placement of the LAP-BAND® System is major surgery and, as with any surgery, death can occur. Possible complications include the risks associated with the medications and methods used during surgery, the risks associated with any surgical procedure, and the patient’s ability to tolerate a foreign object implanted in the body. Band slippage, erosion and deflation, reflux, obstruction of the stomach, dilation of the esophagus, infection, or nausea and vomiting may occur. Reoperation may be required. Rapid weight loss may result in complications that may require additional surgery. Deflation of the band may alleviate excessively rapid weight loss or esophageal dilation.

Important: For full safety information please click here, talk with your doctor, or call Apollo Customer Support at 1-855-551-3123.

CAUTION: Rx only.