Photo Release Form | Healthy Smiles Forever

HSF Photo and Media Release Form
I, patient name , grant permission and consent to CHA - Healthy Smiles Forever for the use of the following photograph(s) and personal statements as identified below for presentation, including but not limited to: publicity, copyright purposes, illustration, advertising, and web content.
Photo of Individual or Dental Condition and Reson Healthy Smiles Forever is needed in Long Term Care.
Describe Photo(s)
I understand and agree to the aforementioned terms and conditions.
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HSF Photo and Media Release Form