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.