Photo Consent Form

In order to track progress, we at Superior Skin Care and Electrolysis like to incorporate the use of photos. Photos are used for documentation purposes, email advertisements, social media and other marketing purposes.

Please review the below statement and fill out the attached form to consent:

I consent to having “Before” and “After” photographs of my service/procedure. Photographs will be used for the purpose of documentation and marketing purposes. I understand, by signing this form, I am allowing Superior Skin Care and Electrolysis & Staff to disclose photographs taken of me before, during, and after treatment. 

I understand that once my photographs have been disclosed to Superior Skin Care and Electrolysis, affiliates, successors and assignees the photographs will no longer be protected by federal privacy laws. However, Superior Skin Care and Electrolysis’s affiliates, successors, and assignees will not use the photographs except as permitted on this authorization form. 

I hereby release Superior Skin Care and Electrolysis, its affiliates, successors, and assignees from any claim demand, cause, action, or proceeding of whatever nature arising out of publication and distribution of the said photographs in accordance with the terms of this authorization. By signing this form, I am allowing Superior Skin Care and Electrolysis, affiliates, successors and assignee to disclose photographs taken of me before, during, and after treatment.

Please enter your name (client) to sign this form: *

If applicable, please enter name of guardian to sign this form

Today's Date *

Date of Birth *

Gender *

Email *

Phone *

Address *

Please include street name, unit/apt number if applicable, city, state and zip code.

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