Photo & Video Consent Form

The Photo & Video Consent Form authorizes healthcare providers to capture, store, and use clinical photographs or video recordings of patients. This form is essential for practices that document clinical findings photographically (dermatology, plastic surgery, wound care), use before-and-after photos for treatment planning, or create educational or marketing content featuring patients.

The form clearly distinguishes between different usage categories: clinical documentation for the medical record, educational use for staff training, publication in medical journals or presentations, and marketing or website use. Patients can consent to some categories while declining others -- for example, allowing clinical documentation but not marketing use.

Storage and retention policies are documented, including where photos are stored, how they are secured, and how long they are kept. The patient's right to revoke consent at any time is clearly stated, along with the process for requesting deletion. For minors, parent or guardian consent is required. This template meets the requirements of both HIPAA (as clinical photography constitutes PHI) and state-specific medical photography consent laws.