This printable and customizable authorization form allows IV therapy clinics to obtain informed consent from patients for the release and use of their photographs and related media. It is designed to cover a wide range of applications, including educational materials, marketing campaigns, social media, and clinic websites.

The form clearly outlines the scope of consent, the intended use of images, and the patient’s right to revoke authorization at any time. By using this form, clinics can maintain transparency, protect patient privacy, and ensure compliance with applicable privacy laws and ethical standards.