Image Consent Form
This form enables you to decide what happens to your photos after they have been taken.
As you know, pre-and post- treatment images are always recorded and handled in accordance
with data protection principles. As cosmetic treatments are a very visual speciality it is a
requirement that all of our patients have their photographs taken before and after
treatment. These photographs are stored securely and we adhere to a strict policy of
controlling access to your photographs.
Some people prefer their photographs to be kept private and others are happy for anonymous
versions to be shared with other people considering cosmetic treatments.
We will respect your wishes and would be grateful if you could answer the following questions
regarding how you would like your photographs to be used.
Please tick yes or no to the following questions:
I am happy for my before and after photographs to be
shown to patients considering treatment.
I am happy for my photographs to be shown online
I ____________________________________________________consent to the choices I have
chosen above and confirm that these images were taken with my knowledge.
All Patient details will remain anonymous at all times.
Patient Signature:______________________________________ Date: ____________________________