I permit Delaware Valley Plastic Surgery, PA, Dr. Evan Sorokin, Andrea Conway, PA and their designee(s) referred here as “DVPS” to use the photographs, digital images, or videos (“Images”) I am uploading. These may be of me or parts of my body. They will relate to the procedure(s) done by DVPS. I agree DVPS may share them with staff, other professionals, and the public. I also agree to the disclosure of such images and information related to the procedure (“Information”).
I agree that my provider can keep the images or publish them on the internet. Once they are published DVPS has no control over their use and I agree to give up certain rights to the images. They may be used on commercial websites and social media. I understand my provider has no control over third party use. I release DVPS and my provider from any claim that might arise from any use of these images.
I understand that when this information is published, it is no longer protected by privacy laws. It may be re-published by anyone with access. I also understand that upon disclosure the information may no longer be protected. It may be used by any recipients (including the public). Furthermore even if I request removal from a website or social media, once published this may not be possible.
I understand that I may refuse to permit disclosure. My refusal will not affect the services I receive.
I understand that I can see and copy the images but by uploading them I give them freely to DVPS as DVPS property. I can revoke my authorization at any time. If I do so, it will not affect anything that happened before my revocation.
My information may be used in any media. This includes newspapers, pamphlets, educational films, the Internet (including social media), my surgeon’s website or advertising, and television. I understand my image may be recognizable, especially by people who know me even if my face is not shown. My image, or even a tattoo or birthmark could reveal my identity.
I have read and understood the above information. I fully understand the risks and the policies above.