I consent to photo and/or video images to be taken of me by Dr Katie-Beth Webster or representative.

I understand the images will be a part of my medical record and may be used for purposes of medical teaching or training or for marketing purposes (website, print, digital or social media).

By Consenting to photographs and/or video images I understand I will not be compensated from any party. Although my images will be used without identifying information such as my name, I understand it is possible that someone may recognise me.

I further acknowledge that my participation is voluntary and agree that use of any photos and/or video images confers no rights of ownership. If I wish to withdraw my consent in the future, I may do so via written request to Dr. Katie-Beth Webster