Patient Photo / Video Release Form
This release is designated to give permission to Dr. Kimi S. Caswell, D.D.S., M.S. to use my photos / videos for educational and promotional purposes. I allow my digital patient photo / video series as well as any photos / videos taken in-office or at patient appreciation events to be shared with others by means of internet and print media including but not limited to: our business website, social media websites and print advertising. Dr. Caswell has permission to use my photos / videos in this manner unless I request that she no longer use them. I understand that I have the option to decline this request, and am not obligated in any way to provide permission to use these photos / videos.
I allow Dr. Kimi S. Caswell, D.D.S., M.S. to use my photos / videos for educational and promotional purposes.