Photo Release



We value our patients' right to privacy and confidentiality, and we take our responsibmties under HIPM and the Texas Medical Records Privacy Act very seriously. The practice exercises great care in the use of patient images and patient identities.

By signing below, you understand that thi┬Ěs authoriizati:on may be revoked at any time merely b,y notifying our office in writing that you wish to no longer allow your photographs to be shared.

Your willingness to allow photography rel:ease wiilll have no effect on the treatment or care you receive frorn our office and staff.

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