SIGNATURE:__________________________________________DATE SIGNED:______________
SPONSOR PLEDGE*
By signing the above, I am stating that I am board-certified in plastic
surgery by the American Board of Plastic Surgeons or the Royal College of Physicians and Surgeons of Canada, that my medical license in the state where I am practicing is current and has not been
revoked (nor has it been revoked in any other state), and that I am not currently being investigated or disciplined, or being considered for discipline, by the Board of Medical Examiners
of any state or country, nor has any Medical Board or comparable supervisory board deemed it necessary to bring disciplinary action against me in the past.
I further state that I will honestly answer any questons my patients ask me regarding malpractice settlements or judgments in the past or present.
I also promise to
inform, immediately, the webmaster of www.BoardCertifiedPlasticSurgeon.com if the
status of any of the above specifications have changed at any time during my listing period.
I understand that listing on BoardCertifiedPlasticSurgeon.com is at the sole discretion of the webmaster of BoardCertifiedPlasticSurgeon.com, I understand that my listing on BoardCertifiedPlasticSurgeon.com may be removed, and the remainder of the unused subscription fee, at a pro-rated monthly basis, up to
6 months, will be refunded to me. I agree with these terms and also agree not to take any legal action, and agree to forfeit the right to any and all legal action, against the webmaster or administrators of www.boardcertifiedplasticsurgeon.com for the removal of my listing.
*
Due to the high-risk nature of a practicing plastic surgeon and the difficulty in checking such claims, and based on the suggestion of several professionals, we have removed the statement "I further state that I have never been successfully sued for medical malpractice" which had previously appeared on our pledge and have substituted:
"I further state that I will honestly answer any questons my patients ask me regarding malpractice settlements or judgments in the past or present."