Photo Release Form
Permission to Take Photographs, Slides, and Videos
I do hereby authorize Dr. Gina McCray/Dr. Kara McCray Demer/and/or St. Mary’s Dental to take photographs, slides, and/or videos of my face, jaw, and the hard and soft tissue of my mouth.
I understand that these photographs, slides, or videos will be a part of my permanent dental record.
I understand that these photographs, slides, and videos may be used for educational purposes in lectures, demonstrations, and professional publications and I hereby authorize said use. If they are used for these purposes, I understand that every reasonable attempt shall be made to conceal my identity.