Client Photo & Video Release Form

Client Photo & Video Release Form
This form seeks for the consent for photographs and videos to be taken by an Enhanced Desires representative.

By signing this form, the client affirms in understanding that the the images and videos may be used for different purposes indicated hereunder.

By consenting to the release of images, you agree that you will not receive any form of compensation in cash or in kind.

You likewise understand that your name will not be included in the images. Nonetheless, it is still possible that someone may still recognize you.

Your refusal to consent to the release of your photographs and videos will not, in any way affect the care you will receive.
I authorize the use of Photographs for the following:*

Educational Purposes such as Procedure DemonstrationSocial Media and Online Publishing adsPrint Marketing AdvertisementsVideo and Television Media Advertisements
Name of Patient
Signature of Patient

Clear
Date Signed

MonthDayYear
Date
Upon submitting this form, you affirm that all your responsibilities and rights have been explained to you.
Should be Empty: