Template · Fillable PDF
Patient Photo & Video Release Form
Have patients sign this before you photograph or film them. It covers your website, social media, ads, online listings and AI search, and makes clear that taking part is voluntary.
- Makes clear participation is voluntary, with no compensation owed
- Covers before-and-after photos, reviews and testimonials
- Includes the HIPAA language and a parent or guardian signature for minors
- Type your practice name in, then print or send
A sample template, not legal advice. Have your attorney review it for your state before you use it.