Free Patient Photo Release Form Template
Patient Photo Release Form
Please fill out the following release form with the correct information.
Patient Information
Name
Date of Birth
Address
Phone number
Authorization Details
I, the undersigned, hereby authorize
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.
Date:
Release Form Templates @ Template.net
