Consent For Images

Clinical photographs play a key role in the education of medical and dental staff at all levels, and thus benefit future patients. All illustrations used will be anonymised (None of the patient identifiable data will be revealed like name or address. Patients will only be referred to as XYZ or assigned a number)

You do not have to enter into this undertaking if you do not so wish. If you do not fully understand any of the below, please ask. If, in the future, you wish to withdraw this consent, you have the right to do so at any time by letting us know in writing. Your choice of consent level will not affect your treatment in any way.

Consent for use of clinical photos by the clinician in the following situations:
• Publication in a journal, textbook, as part of a display or information leaflet or on an open access web site, which may be seen by members of the general public as well as medical and dental professionals
• May be useful for the purposes of dental teaching and research and in view of the explanation given to me, I agree that the illustration may be shown to appropriate professional staff and included in a professionally assessed logbook.
• I understand that the illustrations requested here, to which I have agreed, will form part of my confidential treatment records.

I give consent to the Clinician for my anonymised clinical photographs to be used in the above mentioned situations.