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Photographic / Media / Social Media Consent
Without expectation of compensation or other remuneration, now or in the future, I hereby give my consent to Hughes Orthodontics and its affiliates and agents, to use my image, video and photographic likeness and/or any interview statements from me in its publications, advertising or other media activities (including the Internet and Social Media sites).
I hereby consent to the collection and use of my personal images by photography or video recording.
I further acknowledge that
Hughes
Orthodontics may use my image in media to promote the practice in the future.
I understand that no personal information, such as names, will be used in any publications unless express consent is given.
I also understand that my consent can be withdrawn at anytime in writing to
Hughes
Orthodontic.
I have read the above statements and I give this consent voluntarily.
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