I hereby agree to participate in social media posts with Ocular Therapeutix (Ocular) relating to my utilization of DEXTENZA that may contain images or videos containing my likeness and my facility. I understand that these images may appear on LinkedIn and/or Twitter. I represent that I have the authority to enter this consent on behalf of the facility referenced below. I understand that I may revoke this consent at any time; however, such consent will not affect any social media posts made prior to the date of written revocation.


By signing below, I hereby consent to the above statements.


Model Release
Health Care Professional
I agree