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Mr Nigel G Taylor
MDSc, BDS, FDS RCS(Ed), FDS RCS(Eng), M’Orth RCS(Ed), D’Orth RCS(Eng), FDTFed RCS(Ed)
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Orthodontic Unit The Royal Surrey County Hospital Egerton Road Guildford GU2 7XX
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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.
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