Written Consent for Medical Photography

I consent for medical photographs or video clips to be made of me or my child (or person for whom I am legal guardian). I understand that the images (photo or video) that I’ve provided may be used for purposes of teaching or for publication in medical textbooks or journals as well as presentations and online teaching materials. By consenting to these medical photographs or videos, I understand that I will not receive payment from any party.

By signing this form below I confirm that I’m giving my consent for the images I provided to be used in the ways described above.

Subject's Name *
Subject's Name
Check here if subject is a minor or unable to provide consent
Subject or Guardian's Name *
Subject or Guardian's Name
Typing your name gives consent for the images provided to be used as described above.