Clinical Photography Consent

If a member of the practice team asks you to send a photograph, please complete this form to confirm your consent.

All images received without appropriate consent will be permanently deleted.

Last Updated: 10/01/2025

  • Your Details

    Date of Birth
    For example, 15 3 1984
    Name of Clinician Requesting Photograph
    Please confirm your consent for this image:
    Please confirm you have the appropriate permission to share this image?
    I agree to share my images for the above marked purposes and note that my permission will be sought if the image is requested to be used for any other purpose
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