Patient Marketing Release

I give the dental practice the absolute right and permission to use, copyright and/or publish photographic images, voice recordings and/or video of the patient named below, or in which that patient may be included in whole or in part, or composite in form or character, or reproductions thereof in color or otherwise, made through any media, for patient education, art, advertising, trade or any other lawful purpose.

I also hereby release, discharge, and agree to save the practice, the doctor(s) and staff from any liability for any blurring, distortion, optical illusion, alteration, or use in composite form, whether intentional or otherwise, that may occur or be produced in the creation of said images and/or video, or in any processing needed for the completion of the finished product.

In addition, I give the dental practice the absolute right and permission to use, copyright and/or publish reviews, surveys, testimonials, comments, voice recordings, thank you notes and/or letters created by the patient named below, in whole or in part, through any media, for patient education, advertising, trade or any other lawful purpose.

I also hereby release, discharge, and agree to save the practice, the doctor(s) and staff from any liability for any misstatements, typographical errors, grammatical errors or misspellings, whether intentional or otherwise, that may occur or be produced in the creation of said reviews, surveys, testimonials, comments, thank you notes and/or letters created by the patient named below, or in any processing needed for the completion of the finished product.

Furthermore, I hereby waive any right to inspect and/or approve the finished product that may be used in connection therewith, or the use to which it may be applied.

If you want to print the completed page for your records, you must do so BEFORE you send us the form.