Social Media Consent/Release Form

I, Print Name , hereby authorize Razi Orthodontics to publish and use my photo and/or information related to my experiences at Razi Orthodontics for any lawful purpose, including, but not limited to, their website, social media accounts, and promotional materials, either digital or in print, in perpetuity. I also grant permission to us my name.

By signing and dating this document I authorize Razi Orthodontics to edit, alter, share, remix, tweak, build upon or in any way alter the photograph(s) mentioned above. I also waive any rights of privacy or compensation associated with the use of my photos for the personal or commercial purposes outlined above.