Client Form 03

Photography Consent

Clinical record photography and optional public use are separated so you can make each choice independently.

Client Details

Full name Date

Clinical Photography

Clinical photographs may be used for consultation, treatment planning, progress monitoring and your treatment record.

I consent to clinical photographs being taken and stored as part of my treatment record.

Yes No

Where photographs are retained as part of the treatment record and not used publicly, they may be retained for up to two years following the appointment.

Optional Marketing Consent

This is separate from treatment consent. Saying no will not affect your treatment.

I consent to selected photographs being used by Fallen Skin & Aesthetics for:

Instagram / social media Website / online portfolio Printed marketing / portfolio material

I do not consent to any public or marketing use of my photographs.

No public use

Marketing consent may be withdrawn for future use. Content already published, shared or copied by third parties may not always be capable of complete recall.

Terms & Privacy I confirm that the information I have provided is accurate to the best of my knowledge. I have read the Terms & Conditions and Privacy Policy.

This website version does not transmit medical information yet. The form will be connected to a secure submission system before launch.