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.