Consent to Digital Dental Photography

Consent to Digital Dental Photography

This is to authorise Dr. Sheraz Burki to take digital photographs/videos of my face, jaws and teeth, before, during and after treatment.

I hereby consent to the use of said photographs/videos for the following purposes:

• Dental records
• Dental education including lectures, seminars and demonstrations
• Professional or Marketing publications such as journals or books
• Marketing material both digital (e.g. website) and printed
• Patient education

I understand that if said photographs/videos are used, my name and any other identifying information will be kept confidential.
I do not expect any type of compensation, monetary or other, for the use of said photographs/videos.