Patient Photo Release Consent Form

Thank you for considering sharing your journey with East Coast Plastic Surgery. Please complete the form below to indicate your consent for the use of clinical images for educational or informational purposes. 

All patients will have their photos taken for their confidential file to ensure accurate medical records and treatment tracking. These photos are essential for documenting progress, planning procedures and providing the highest standard of care.

East Coast Plastic Surgery would like to ask you for permission to share the corresponding photographs for educational purposes as these images are highly beneficial in assisting other patients when making informed decisions about their surgical options. Be assured that names will not be disclosed, and any identifying features will be obscured if requested.

Do you consent to your clinical photographs being used:

All patient photographs are stored within a password protected practice management software solution that can only be accessed by surgeons and staff of East Coast Plastic Surgery. This is in compliance with the Australian Privacy Principles.

Declaration: I declare that I am over 18 years of age and legally competent to provide consent. I have read and fully understand the content and implications of this consent form. I have been informed that my identity will be protected, and my personal information will remain confidential. I am aware that I can withdraw my consent at any time by emailing info@ecplasticsurgery.com.au to request this, but understand that once my photos have been published, they may remain in circulation. I understand that any image of myself that is used in advertising, particularly on social media platforms, may be used by or commented on by a third party without East Coast Plastic Surgery’s or my knowledge. By signing below, I acknowledge and agree to the above statements and give my consent for the use of my photos as described.

A copy of this consent form is to be emailed to jessica@ecplasticsurgery.com.au and cosmetics@ecplasticsurgery.com.au when submitted.

You Must Be Over 18 To View This Site

From 01 July 2023, the Australian Government requires confirmation that visitors to our site are over 18.