SKIN/tervention by Dr. Zoë Indigo, MD
This form is optional. Signing it lets SKIN/tervention share your photos. Your care is the same whether you sign or not.
What I am authorizing
I authorize SKIN/tervention by Dr. Zoë Indigo, MD, including Dr. Zoë Indigo, MD and her staff, to use and share the following:
- Photos and videos of me taken at the practice before, during, and after my treatment
- The name of the treatment or treatments shown in those photos
- A general description of my results
Where my photos may be shared
- Social media (Instagram, TikTok, Facebook, Threads)
- Practice websites and email newsletters
- Printed and in-office materials
- Medical lectures and educational presentations
My rights
- This is voluntary. I do not have to sign. My treatment, payment, and care do not depend on whether I sign.
- I can change my mind. I can cancel this authorization at any time by writing to hello@drzoe.skin. The practice will stop using my photos and remove them from its own accounts and website. Canceling does not undo uses made before the practice received my request.
- Shared photos can travel. Once photos are posted, other people may copy, save, or re-share them. Photos shared this way may no longer be protected by federal or California privacy laws, and the practice cannot recall copies made by others.
- No payment. I will not be paid for the use of my photos. The practice is not being paid by any outside company to share them.
- I can have a copy. I have the right to receive a copy of this signed form.