I consent for photographs and/or videography to be taken of me or part of my body in connection with the reason listed at the top of this form. I provide this authorization as a completely voluntary contribution in the interest of helping others learn more about the Company or about a specific medical condition or procedure. I understand that I will receive no financial compensation. My refusal to provide consent or participate will not subject me to any retaliatory treatment by RadNet or any of its agents or representatives.
I understand that such photographs and/or videos shall become the property of RadNet in perpetuity for the purpose of including them in any print, visual, or electronic media; specifically including, but not limited to, a Company website, Company-related marketing campaign, Company-related social media post, Company-related print material, and medical journals or text books, for the purpose of informing the medical profession or the general public about the services offered and/or the medical procedures and methods used by this Company.
I understand that I may refuse to authorize my photograph/video to be taken or used for these purposes and that my refusal will not affect my status as an employee, contractor, patient or guest of the Company. If I authorize to have my photo/video taken or used, I understand that I have the right to revoke this authorization in writing at any time and if I do so, it won’t have any effect on any actions taken prior to my revocation.
I hereby consent to and authorize the use and reproduction of my photographic image by RadNet, one of its affiliated subsidiaries, their legal representatives and successors, as well as persons and companies acting with their permission, of any and all photographs or video taken of me for the reason listed at the bottom of this form.
In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising out of, or related to, the use of the photograph/video.
I hereby forever release and discharge the same from any and all claims, actions and demands arising out of or in connection with the use of said photograph/video, including, without limitation, any and all claims for invasion of privacy and libel, including any claim for payments in connection with the distribution of publication of the photographs.