Consent to Dental Photography - ?· Consent to Dental Photography I, _____ (Patient name), hereby authorize…

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    19-Mar-2019

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<p>Consent to Dental Photography I, ______________________________ (Patient name), hereby authorize Bowers and Oki Family Dentistry, PC to take photographs and/or videos of my face, jaws and teeth before, during and after treatment. I consent to allow the photographs to be used for the following ___ Dental Records, dental research, and dental education including study clubs, lectures, demonstrations, professional publications ___ Marketing material including websites, printed materials, and patient education I further understand that if the photographs and/or videos are used, my name or other identifying information will be kept confidential. I do not expect compensation, financial or otherwise, for the use of these photographs. Signature: _______________________________________________ Date: ____________ Parent/Guardian (for minors): ________________________________________________ Witness: ________________________________________________ Date: ____________ </p>

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