Photo Release Form

What the form covers

By signing, the patient authorises your practice and its staff to use photographs, images and related materials of their dental treatment and results for educational, promotional and marketing purposes, on social media, websites and print.

• Grants the right to use, reproduce, distribute, display and publish the materials (including the patient’s name and any testimonial) across media and formats
• Releases the practice and its employees from claims arising out of the agreed use of the materials
• Acknowledges the materials may be viewed publicly and commented on by others on social media and websites
• The patient may revoke authorisation at any time in writing; the practice will then stop using the materials going forward, though materials already used before revocation are acknowledged
• Consent is given voluntarily, having read and understood the terms; space is provided for the patient (and parent/guardian if a minor) and a staff witness to sign

Download the editable form above to add your practice name and details and capture the patient’s signature.