Endermologie Photography Video Marketing Consent Form

Clinical photographs and/or videos may be taken before, during and after treatment for documentation purposes.

CLIENT DETAILS

Full Name(Required)

Date of Birth

Phone

Treatment Date

PHOTOGRAPHY & VIDEO CONSENT

Photography & Video Consent — Please select one option(Required)

I consent to photographs/videos being taken for my confidential clinical records only.

I consent to photographs/videos being used for staff training and educational purposes only.

I consent to photographs/videos being used for marketing purposes.

MARKETING PLATFORMS

Marketing use may include:

Instagram
Facebook
TikTok
Website
Printed marketing materials
Educational presentations
Email newsletters
Online advertising campaigns

CLIENT ACKNOWLEDGEMENT

I understand that:(Required)

My first name only may be used.

No identifying personal information will be disclosed without my separate written consent.

Images may be edited for size, brightness and formatting but will not be altered in a misleading manner.

I will not receive financial compensation for the use of my images or videos.

I may withdraw my marketing consent in writing at any time for future use; however, materials already published may not be removable from all platforms.

I understand that social media and internet platforms are public and Bayside Endermologie Health & Wellness cannot control how third parties may view, share or distribute published content.

I understand that refusal to provide marketing consent will not affect my treatment in any way.

I may request a copy of this consent form at any time.

CONSENT SELECTION

Consent Selection(Required)

Clinical Records Only

Training & Education

Marketing & Social Media

Full Consent (Clinical Records + Training + Marketing)

No Photography / Video Consent (except where required for clinical records)

SIGNATURES

Client Signature(Required)

Date(Required)

Practitioner Signature

Date(Required)

CLIENT DETAILS

PHOTOGRAPHY & VIDEO CONSENT

MARKETING PLATFORMS

CLIENT ACKNOWLEDGEMENT

CONSENT SELECTION

SIGNATURES

Contact Info

Useful Links

Our Treatments

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Endermologie Photography Video Marketing Consent Form

Ultraformer MPT Patient Consent Form

CLIENT DETAILS

PHOTOGRAPHY & VIDEO CONSENT

MARKETING PLATFORMS

CLIENT ACKNOWLEDGEMENT

CONSENT SELECTION

SIGNATURES

Contact Info

Useful Links

Our Treatments

Your Cart Contents