Photography Release

I, _____________________________________,
hereby authorize Dr. Garrett D. Olive, or his staff to take photographs, slides, and/or videos of my face, jaws, mouth, and teeth.
I understand that the photographs, slides, and/or videos will be used as a record of my care, and may be used for educational purposes in study club meetings, lectures, seminars, demonstrations, and professional publications (journals, magazines).
I understand and give permission to use the items listed above as use of any advertising or marketing brochures, social media, or printed material to increase growth within our dental practice. 
I understand and give permission to include my name or other identifying information with the photographs, slides, and/or videos on any advertising material. 
I do not expect compensation, financial or otherwise, for the use of these photographs. 

Signature: __________________________________
Date: ______________________________________

Thank you for your trusting us with your dental care!!
Midtown Dental