Patient
Image Consent

PHOTO / VIDEO RELEASE
AND CONSENT FORM

Clinic Name: Bodrum Dent Halikarnas Oral and Dental Health Clinic
Address: Konacik Mh. Ataturk Blv. No: 203 C / 1 Bodrum Mugla Turkey
Phone: +90 252 363 94 84
Email: info@denthalikarnas.com
Web: www.bodrumdenthalikarnas.com

I hereby give my explicit consent for the clinic mentioned above to
use my photos and/or videos for promotional and informational purposes on:

- Website
- Social media (Instagram, Facebook, etc.)
- Printed/digital promotional materials
Images may include my full face or only the oral/dental area.

I have been informed that I can withdraw this consent in writing at any time, and that it will not affect my treatment.