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Simplify the process of obtaining consent for using patient images with our professionally designed Patient Photo Release Form Template. Tailor it effortlessly to your needs using our AI Editor Tool, ensuring compliance and clarity. Perfect for medical practices, research projects, or marketing purposes, this template streamlines documentation while prioritizing patient trust and privacy.
Please fill out the following release form with the correct information.
Patient Information
Name
Date of Birth
Address
Phone number
Email
Authorization Details
I, the undersigned, hereby authorize[Your Organization Name]to use photographs and/or videos of me for the purposes indicated below. I understand that these images may be used in various formats, including print, digital media, or educational materials, and may be shared publicly.
Intended Use
Educational Purposes
Marketing and Advertising
Social Media
Research and Publications
Internal Use Only
Terms of Agreement
I understand that my image may be used without compensation.
I acknowledge that my participation is voluntary and can be revoked by written request at any time.
I confirm that this release form has been fully explained to me, and I understand its contents.
