An Invitation to be part of our Educational & Marketing Portfolio

 

Professional patient consent form and model release for

Photographic, video & written testimonial reproduction

  • In cases where the patient has died or is incapable of giving consent, consent may be given by the next of kin. If the patient is under the age of 16, consent should be given by a parent or guardian.
  • An Invitation to be part of our Educational & Marketing Portfolio

    Please tick below to confirm whether or not you would like us to; include identifiable / non-identifiable video(s) and photograph(s) of me / my son/daughter and written testimonial(s) in patient information and education resources including printed and online leaflets, brochures, CDs, websites, advertising, video hosting sites including YouTube, social media sites including Facebook, Instagram, Internet search engines including Google, and other Internet Publications, for perpetual and commercial use.
  • In cases where the patient has died or is incapable of giving consent, consent may be given by the next of kin. If the patient is under the age of 16, consent should be given by a parent or guardian.
  • Photography Consent Signature
  • Date Format: DD slash MM slash YYYY