Photo Release Consent Form - E33 Esthetics
Please read and sign this consent form to authorize the use of your photographs for promotional and marketing purposes. We will not release any private medical records and will comply with HIPAA laws. We will not use your legal name unless otherwise stated and agreed upon by both parties. By completing this form you waive all rights and financial claims to photos and videos. Thank you.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Signature
*
Date of Signing
*
-
Month
-
Day
Year
Date
I Consent to the Use of My Photos
I Consent to the Use of My Photos
Should be Empty: