United States of America v. Associated Foot & Ankle Centers of Northern Virginia - Settlement Agreement

Exhibit B

RELEASE OF ADA CLAIMS

For and in consideration of the acceptance of relief offered to me by Associated Foot & Ankle Centers of Northern Virginia (“AFAC”) pursuant to a Settlement Agreement between the United States and AFAC: I, _________________, release and discharge AFAC from all legal and equitable claims under, arising out of, or related to the complaint described in paragraph 2 of the Settlement Agreement between the United States and AFAC concerning AFAC's failure to provide effective communication in violation of the Americans with Disabilities Act.

This Release will be considered null and void in the event that AFAC fails to send a check in the amount specified in the Settlement Agreement within ten (10) days of receipt of this signed Release.

I HAVE READ THIS RELEASE AND UNDERSTAND THE CONTENTS THEREOF AND I EXECUTE THIS RELEASE OF MY OWN FREE WILL.

Signed this _______ day of ____________, 2014.