• DENTAL PHOTOGRAPHY CONSENT FORM

    DENTAL PHOTOGRAPHY CONSENT FORM

  • Patient Consent
    I,         Pick a Date. Give consent to BellaVista DentalCare to use dental images and/or video made of me or my child/dependent(s). 


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    Full Face

    Lower Face

    I agree that the images may be:
    (please initial below to show consent)
  • By signing below, I confirm that I understand this consent form.

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    Pick a Date
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