Social Media Photo Highlight & Release Form

Social Media Photo Highlight & Release Form

Thank you for your interest in sharing your smile with the world! By submitting your photos and success stories, you’re helping inspire others on their own smile journey. While we greatly appreciate your effort, please note that we may or may not choose to use your photo. Your willingness to share is valued, and regardless of our decision, we’re grateful for your contribution. Keep smiling bright!
Name*

First NameLast Name
I give my consent for Speaker Orthodontics to use photographs/videos for social media and marketing purposes, including social media, website, promotional materials, and/or educational materials for myself and any dependents.

I understand that these images/videos may be used for marketing and educational purposes and that they may be viewed by the general public. I acknowledge that I will not receive any compensation for the use of these images/videos.

I have read and understand the terms of this release.
Authorization and Release
Any additional info you'd like us to add: (Accomplishments, reviews, how you like braces, how braces changed your confidence, helped you achieve success, etc.). We would love to hear your success stories and highlight them!
Add any photos you would like included here:

Cancelof
Signature

Powered by Jotform SignClear
Date Signed

MonthDayYear
Date
Should be Empty:

Authorization and Release