SOCIAL MEDIA / PHOTO CONSENT FORM
ELEVATION ORTHODONTICS (EO) WOULD LIKE YOUR PERMISSION TO USE IMAGES TAKEN IN OFFICE TO SHOWCASE EXTRAORDINARY BEFORE AND AFTER SMILES ON OUR WEBSITE, FACEBOOK, INSTAGRAM, AND OTHER IN-OFFICE MATERIALS.
PLEASE INDICATE BELOW THE FOLLOWING AREAS WHERE YOU CONSENT TO THE USE OF YOUR PICTURES:
EO WEBSITE
EO FACEBOOK/INSTAGRAM
EO IN-OFFICE MATERIALS (NEWSLETTER, ETC.)
I GRANT PERMISSION FOR PHOTOGRAPHS OF ME TO BE USED IN THE FORMATS INDICATED ABOVE.
I GRANT PERMISSION FOR PHOTOGRAPHS OF ME TO BE USED FOR IN-OFFICE EDUCATION USE ONLY.
I DO NOT GRANT PERMISSION FOR PHOTOGRAPHS OF ME TO BE USED IN ANY OF THE FORMATS INDICATED ABOVE.
PATIENT/PARENT OR GUARDIAN SIGNATURE
Date: