Clinical Photograph Consent

Clinical Photograph Consent

Patient First Name *

Patient Surname *

Procedure

I give permission for clinical photgraphs to be taken:

As part of my initial consultationAs part of my post operative recovery (if surgery is required)For medical educational purposes (eg: shown to other doctors)For education purposes (eg: shown to other patients)For public eduction purposes (eg: social media before & afters, blog posts on websites etc)

At your request, we can also remove any identifying marks ie: tattoos or birthmarks. Please write your request:

Please note that all photographs will be de-indentified where possible.

All photos taken by our practice at the time of consultation and post operatively are stored in an external secure programme.

Signature *

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Date *