15 / 10 / 2025
We respect your privacy.
Some images of you will be needed for your treatment, and this form asks for your permission
for Leeming Dental to store and use them. You can also choose whether your images may be
used to support learning or awareness in dentistry.
Please let us know how you’re happy for your images to be used.
I,
, give permission for Leeming Dental to take and use photos or videos
of me (including x-rays and models), or of a child under 16 for whom I am the parent or legal guardian.
I understand the following:
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Some images are necessary for treatment and will be stored in my dental records.
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Once images have been used, I cannot take this permission back.
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I do not have any ownership rights to the images and will not receive payment or other benefits.
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My name and identifying details will always be kept private.
How we may use your images
Please review the options below and tick the boxes you’re comfortable with. Level 1 is required so we can
store your images in your dental records. Levels 2 and 3 are completely optional—but by choosing them, you
can help support education and improve care for other patients.
- Your images will be stored securely as part of your private dental file
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a. Used in clinical teaching and/or research, shown only to appropriate clinical staff and students
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b. Displayed on restricted-access educational or institutional websites for staff and students
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c. Used to demonstrate treatment modalities to other patients
- a. Published in professional journals, textbooks, or included in lectures
- b. Used in marketing or promotional materials
- c. Published on open-access websites or social media platforms (like Facebook, Instagram, TikTok, X,
etc.) where anyone can view or download the content
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