The RestorEar ReBound has not been evaluated by the Food and Drug Administration. It is not intended to diagnose, treat, cure, or prevent any disease. It is not meant to substitute for medical advice from a healthcare professional. You should not use the information contained herein for diagnosing or treating a health problem or a disease, or for prescribing any medication. If you suspect that you have a medical problem, promptly contact your regular healthcare provider.

The risk associated with using ReBound is low. Risks include and are not limited to:

• - Numbness
• - Redness
• - Dizziness
• - Mild headache
• - Temporary vision changes

Do not operate a vehicle or machinery while using ReBound. If you experience any unusual side effects, immediately remove ReBound and consult a medical professional. The RestorEar ReBound Test Study is intended for research purposes. Responses may be used for RestorEar marketing, advertising, promotions, and/or outreach. While responses are not anonymous, personal information including your name, phone number, and email address will not be released.

Consent Form

In order to proceed to ReBound feedback, please carefully read through the following information and check the box below.

• - I have read and understand the requirements for participation in the RestorEar ReBound Test Study and consent to participating.
• - I understand the risks associated with participation in the study and use of the RestorEar ReBound.
• - I understand that the RestorEar ReBound is not a medical device and is not regulated by the Food and Drug Administration.
• - I understand that the RestorEar ReBound is not intended to diagnose, treat, cure or prevent any disease or to substitute for medical advice from a physician or other medical professional.
• - I understand that my responses are intended for research purposes and will not be anonymous.
• - I understand that my responses may be used for RestorEar marketing, advertising, promotions, and/or outreach, and I authorize the release of this information.
• - Upon submission of this form, I agree to complete the study to the best of my ability.