Photography consent

Dr. Mark Safari DDS & Associates
Newtonbrook Dental (416) 223-2453
Forestwood Dental (905) 770-0099

Patient Name

I (Patient), authorize Dr. Mark Safari DDS, to take photographs, and/or videos of my face, jaws and teeth, before, during and after treatment. I consent to allow the photographs to be used for the following:

  • Dental Records
  • Dental Research
  • Dental Education including lectures, seminars, demonstrations, professional publications such as journals or books
  • Marketing material such as social media, our office websites, Instagram, Twitter, Facebook etc. as well as printed materials, and patient education.

I further understand that if the photographs and/or videos are used, my name or other identifying information will be kept confidential. I do not expect compensation, financial or otherwise, for the use of these photographs.

Name of patient:
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