Request for removal of visual memory prosthetic, visual filter, or other protective or corrective eyewear

This is an agreement (hereafter referred to as Agreement) pertaining to the
safe inspection and handling of a visual memory prosthetic, visual filter,
Laser EyeTap (TM) eyewear, EyeTap (TM) device, or visual information processor
(hereafter referred to as Prosthetis), from a user, wearer, patient, or
experimental subject (hereafter referred to as Wearer).

If Prosthesis includes means for directing light into an eye of wearer, or
means and apparatus responsive to light that would otherwise enter an eye
of Wearer (hereafter referred to as EyeTap), I agree to ensure that my
inspection will not alter the optical path of any light passing through
or produced by EyeTap, or that if I must alter the optical path of
EyeTap (such as by moving EyeTap), I understand that Wearer may have
acquired sensitivity to coherent light not processed by EyeTap, and that
Wearer may be subject to dizziness, nausea, headache, or other effects
caused by perturbation of the optical path of EyeTap, and I agree to assume
responsibility from any adverse effects caused by my inspection.  I further
agree to specify the following terms of my inspection, and agree to be bound
by these terms:

I will not subject Wearer to light levels in excess of ________________
during my perturbation of said optical path.

I will not subject Wearer to visual stimulus exceeding ______________ during
my perturbation of said optical path.

I agree to assume responsibility for any damage caused to Prosthesis or
Wearer as a result of my inspection.

I further agree to nondisclosure and nonuse of any aspect of the Intellectual
Property embodied in Prosthesis.  I assign any and all data I may derive,
or cause to be derived, from my inspection of Prosthesis, including but not
limited to data derived from devices with recording capability, and the
media and systems upon which said media exist, to Wearer.

If I jointly participate in an inspection of said Prosthesis, I agree to be
jointly and severally bound by the terms of this Agreement.

Request for inspection of visual memory prosthetic, physiological monitor, or other body--worn processor or monitor

This is an agreement (hereafter referred to as Agreement) pertaining to the
safe inspection and handling of a visual memory prosthetic, or other body--worn
processor (hereafter referred to as Prosthetic), possibly including a
physiological monitor, which may include direct connection to the body of a
user, wearer, patient, or subject of experimental apparatus (hereafter referred
to as Wearer).

I request to have Prosthesis at least partially removed from body of Wearer,
for purposes of my inspecting said Prosthesis.

If I will be touching Prosthesis or if I will come into contact with the
skin of the body of Wearer, I agree that I have washed my hands
immediately prior to touching Prosthesis, and that I carry or bear no
contaminants.  I further certify that I am free of any Chemical Agents,
said Chemical Agents including but not limited to any manner of perfume
or cologne, and that I have had a thorough soap shower within the past
24 hours, and that any and all clothing I am wearing is clean.

I agree that I will be the only person to inspect Prosthesis, and will do
so only in the presence of Wearer.

If I use Instruments to assist in my inspection, said instruments including
but not limited to Chemical Agent Monitor, or dog or other animal, I agree to
assume responsibility for said Instruments and their possible effect on
Prosthesis.  I agree to keep Prosthesis free of saliva from said dog, or
from Chemical Agents that may have accumulated on said Chemical Agent Monitor.

I agree to maintain all contact points of body of Wearer in clean and
sanitary condition, and to provide Wearer with a clean and private
environment in which Wearer can replace Prosthesis after my inspection.

I agree that Prosthesis will remain operational during my inspection,
and that Prosthesis will remain responsive to any and all electrodes or
other connections to Wearer's body during my inspection.

I agree to assume responsibility for any damage caused to Prosthesis or
Wearer as a result of my inspection.

I further agree to nondisclosure and nonuse of any aspect of the Intellectual
Property embodied in Prosthesis.  I assign any and all data I may derive,
or cause to be derived, from my inspection of Prosthesis, including but not
limited to data derived from Instruments or other devices with recording
capability, and the media and systems upon which said media exist, to Wearer.

If I jointly participate in an inspection of said Prosthesis, I agree to be
jointly and severally bound by the terms of this Agreement.

Request for X--ray inspection of visual memory prosthetic, physiological monitor, or other body--worn processor or monitor

This is an agreement (hereafter referred to as Agreement) pertaining to the
safe inspection and handling of a visual memory prosthetic, or other body--worn
processor (hereafter referred to as Prosthetic), possibly including a
physiological monitor, which may include direct connection to the body of a
user, wearer, patient, or subject of experimental apparatus (hereafter referred
to as Wearer).

I request to have at least a portion of Prosthesis completely removed from body
of Wearer, for purposes of my X--ray inspection of said Prosthesis.  I wish to
expose Prosthesis to a level of radiation not to exceed ________________.

I understand that Prosthesis is not a mass--produced product tested for
withstanding X--rays, and therefore I agree to assume responsibility for
possible adverse effect of X--ray expsoure to Prosthesis.
I agree to assume responsibility for any damage caused to Prosthesis
as a result of my inspection.

I further agree to nondisclosure and nonuse of any aspect of the Intellectual
Property embodied in Prosthesis.  I assign any and all data I may derive,
or cause to be derived, from my inspection of Prosthesis, including but not
limited to data recorded by computer systems or devices associated with the
means and apparatus of X--ray inspection and the media and systems upon which
said media exist, to Wearer.