Patient Consent – Terms and Conditions
Photograph & Video Release Form
1. I hereby grant permission to the rights of my/my child’s image, likeness and sound of my/my child’s voice as recorded on audio or videotape without payment or any other consideration.
2. I understand that;
2.1 My/my child’s image may be edited, copied, exhibited, published or distributed
2.2 I waive the right to inspect or approve the finished product wherein my/my child’s likeness appears.
2.3 I waive any right to ownership, royalties or other compensation arising or related to use my/my child’s image or recording.
2.4 This material may be used in commercial settings within a general geographic area.
Photographic, audio, or video recordings may be used for the following commercial purposes:
a) Digital Advertising (Paid Advertising)
b) Digital Marketing (Email and Online Platforms)
c) Angle House Social Media Channels
d) Print Media such as Flyers, Posters, Banners, Display panels
e) Newspapers, magazines or broadcasts approved by the Angle House Orthodontics
f) Electronic publications including, but not limited to, The Angle House Orthodontics website and intranet, and other electronic publications
3. By signing this release, I understand this permission signifies that;
3.1 Photographic or video recordings of me/my child will be electronically displayed via the Internet or in the public setting as listed above
3.2 Photographic or video recordings may be shared with third parties such as the NHS to promote a piece of work.
3.3 I will be consulted about using the photographs or video recordings for any purpose other than those listed above.
3.4 There is no time limit on the validity of this release
3.5 There is no geographic limitation on where these materials may be distributed.
3.6 This release applies to photographic, audio or video recordings collected as part of the sessions listed on this document only.
4. I understand I have the right to withdraw my consent at any time by contacting our marketing team by phone at 0203 096 0111 or email: email@example.com. It is important to note any consent withdrawn will only relate to the future use of captured images or video.
5. I understand that Angle House Orthodontics will not be obligated to use all or any of the images and videos taken.
6. By signing this form, I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organisation utilising this material for the above listed purposes.
Each Angle House Orthodontics practice is independently owned and operated.
This document was reviewed on:
1st January 2022.