Lightfolio Forms

Patient Photo Release

Create easy-to-use photo releases for your patients
Photo release form
  • Agreement This release form is an agreement between you and your client to use their image. Be sure to identify all involved parties.

  • What's Included Spell out the exact terms to use in your release. Outline acceptable uses, compensation (if any) and more.

  • Complete online A convenient and easy-to-use way to obtain a photo release. Have your clients complete this form online, on any device.

Patient Photo Release

  • Patient Name
  • Please select all that apply
  • Terms
  • I (the Client) hereby grant and authorize COMPANY NAME (hereinafter The Company) the right to take, edit, alter, copy, exhibit, publish, distribute and make use of any and all photos and videos taken of me to be used in and/or for any lawful purpose.

    This authorization shall continue indefinitely, unless I otherwise revoke this authorization in writing.

    I waive the right to inspect or approve any finished product in which my likeness appears.

    I agree to this release without being compensated. I waive any right to royalties or other compensation arising or related to the use of the video.

    I hereby hold harmless and release The Company from all liability, petitions, and causes of action which I, my heirs, representative, executors, administrators, or any other persons may make while acting on my behalf or on behalf of my estate.
  • Patient Signature

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