DentalCloudFree template · Word and fillable PDF
Dental photography consent form template
A clear, one-page consent form for clinical photographs. Patients tick yes or no for each use: teaching, journals, your website, social media and your portfolio. Versions for the UK and Ireland, and for the US.
What the form covers
1. Photographs for dental care
Explains that clinical photographs are part of the dental record, used to plan treatment and check results, and kept for as long as the record. No signature is needed for this use.
2. Optional uses, one tick per line
The patient chooses for each use below: yes even if they could be identified, yes only if they cannot be identified, or no. Saying no never affects treatment.
3. The patient's rights
How to withdraw consent or revoke the authorization, what happens to images already published, and who to complain to.
4. Signatures
Patient or representative (with relationship or authority for minors and patients who cannot consent), date, and the clinician's name and signature.
The patient's choices
| Use | Yes, even if identifiable | Yes, only if not identifiable | No |
|---|---|---|---|
| Teaching and training dental professionals | |||
| Professional journals, lectures and conference presentations | |||
| The practice website and printed material | |||
| The practice's social media accounts | |||
| My dentist's professional portfolio of their work |
Two versions, written for each set of rules
UK and Ireland
- Clinical photos held as health data under UK GDPR or the GDPR in Ireland
- Separate, specific consent for every use beyond care, as the GDC expects
- Withdrawal at any time, with website and social media removal within 30 days
- Complaints to the ICO (UK) or the Data Protection Commission (Ireland)
- A4 page size
US
- Written HIPAA authorization for uses beyond treatment, payment and operations
- Statement that treatment does not depend on signing
- Right to revoke in writing, and the redisclosure warning
- Expiry date or event, defaulting to 5 years
- US Letter page size
For the detail behind the form, read our guide to patient consent for dental photos and GDC record keeping for clinical photography.
Common questions
Do I need consent to take clinical photographs?
Photographs taken for a patient's care are part of their dental record. In the UK and Ireland they are processed as health data for care, and in the US they are used for treatment under HIPAA, so you don't need separate signed consent for that. You should still tell patients you take them. You do need explicit consent (UK, Ireland) or a written authorization (US) for anything beyond care, such as teaching, publication, your website or social media.
Is one consent enough for social media and journals?
Use separate choices. Patients often agree to teaching but not social media, or only if they cannot be identified. The template asks about each use on its own line, which makes the consent specific and easy to show later.
What if a patient withdraws consent?
Stop any new use and remove the photographs from your website and social media. You cannot recall material already printed or published by others, and the form tells the patient this up front.
Can a parent sign for a child?
Yes. The signature section has space for a parent, guardian or legal representative to sign and state their relationship or authority. In the UK, a young person who understands the decision may be able to consent for themselves.
Is this template legal advice?
No. It is a starting point. Add your practice details and check it with your indemnity provider or legal adviser before you use it.
Keep consented photos safe and easy to find
DentalCloud stores clinical photos by patient, encrypted, with location data stripped on upload. Free for up to 10 patients.