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Anodyne Pain & Wellness Solutions > Patient Information > Patient Forms > Photo Consent and Release Form

Photo Consent & Release Form

We are always looking to share our patients and their success stories with others. That’s why we ask to be able to take your photo or share your story. Below is our photo consent and release form. You have two options to complete it. Download the PDF, print it off and fill it out, and bring it to your appointment. OR complete the form online prior to your visit.

I consent for photographs and/or video images to be taken of me by Anodyne Pain & Wellness Solutions of Central Ohio or a representative. These images or clips may be shared with staff, other physicians or healthcare professionals, and members of the public for educational or marketing purposes.

By consenting to photographs and/or video images I understand I will not be compensated from any party. I acknowledge that my participation is voluntary and agree that use of any photographs and/or video images confers no rights of ownership or royalties whatsoever.