I understand that photographs, digital images, or other images may be recorded to document my care and for research purposes, and I consent to the recording and retention of the images by Podiatry Care Plus, study sponsors, investigators, and/or research collaborators and partners.

I understand that Podiatry Care Plus will retain ownership rights to these photographs, digital images, or other images, but I will be allowed access to view them or obtain copies. I understand that these images will be stored securely to protect my privacy and will be kept for the time required by law or outlined in Podiatry Care Plus’ policy.

Images and patient data used for education, training, or research purposes will not have any identifying patient information available to sources outside of Podiatry Care Plus and its business associates providing products and services to Podiatry Care Plus.

Images and patient data that identify me will only be released and used outside Podiatry Care Plus and its business associates upon written authorization from me or my legal representative.

I understand treatment is not conditioned upon my consent. I can revoke my consent in writing, which is effective when Podiatry Care Plus receives it. My written revocation is not effective if Podiatry Care Plus has taken actions in reliance on a valid consent.

To revoke this authorization, I may do so in writing by notifying info@podiatrycareplus.com. Even if I revoke this authorization, Podiatry Care Plus may still use or disclose health information already obtained about me as necessary to maintain the integrity or reliability of the current research. Once research has been published or presented, it will not be possible to withdraw authorization.