Social Media Release Form at Anastasia Medical Aesthetics

I authorize the use of my photographs and videos in the formats listed below. 

I understand that I will never be identified by name in any use of these photographs and videos, but that in some circumstances the photographs and videos may portray features which can make my identity recognizable.

I agree that the images may be used for all of the following:

• Placed in my medical record for future treatment. 

• Used in marketing materials in social media postings such as Instagram, Facebook, TikTok etc. 

I waive any right to inspect or approve the finished product and advertising.

I understand that once my images and videos are published, I lose control and rights to these images and videos, the individual social media platforms may assume control and rights to those images and videos, and that the images and videos posted on the Internet can be altered and/or archived, and are permanent and searchable. 

I understand that my participation is voluntary.

Before signing this document, I have considered my decision carefully.

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I hereby give permission to Dr. ILONA DUBUSKE to use my photographs and videos as outlined in this document. 

Clicking ‘‘Yes’’ constitutes my certification to this Document. This electronic signature will have the same legal effect as a handwritten signature.
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