Photo & Media Consent Form

Section 1 – Client Information

Full name

Last name

Date of birth

Month

Day

Year

Appointment date

Section 2 – Clinical Photography Consent

I authorize DEMRÉ Clinical Spa to take photographs and/or videos before, during, and after my treatment for clinical documentation, treatment planning, and progress tracking.

I understand these photographs become part of my confidential client record and will be stored securely.

Section 3 – Marketing & Promotional Consent

Do you authorize DEMRÉ Clinical Spa to use your photographs and/or videos for marketing and educational purposes?

Section 4 – Client Acknowledgment

I understand that allowing or declining marketing use of my photographs will not affect the quality of care or treatment I receive.

I understand I may revoke my marketing consent in writing at any time for future use; however, previously published materials may not be able to be removed from third-party platforms.

I certify that I have read and understand this Photo & Media Consent Form.

Section 5 – Electronic Signature

Electronic signature

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Signature date