Mr Nigel G Taylor

 

MDSc, BDS, FDS RCS(Ed), FDS RCS(Eng), M’Orth RCS(Ed), D’Orth RCS(Eng)

 

 

 

 

 

 

 

Brockley House

Pilgrims Way

Guildford

GU4 8AD

 

Office:       01483 531507

info@brockleyhouseorthodontics.co.uk

www.brockleyhouseorthodontics.co.uk

 

 

Consent To Photography

 

 

 

Name            ……………………………………………

 

Date of birth            ……………………………………

 

 

I understand that photographs will be used to assess and monitor the dentition. They will form part of the confidential clinical records and as such may be shown to appropriate clinical staff.

 

It has been explained that these pictures may be of educational use.

 

I agree to them being used for teaching purposes and in educational publications – including electronic publications. As a result, although meant for health staff, these photographs may be seen by the general public.

 

I understand that every effort will be made to conceal identity but full confidentiality cannot be guaranteed.

 

 

 

Signature ……………………………………

 

Date …………………

 

 

To comply with the 1998 Data Protection Act may I confirm that personal data is recorded and processed in order to provide orthodontic care. This information remains confidential.