Consent for use of photos

"To Whom it may concern

 

I ………………………………………………….

Of …………………………..

Give my permission for the photographs taken on ……… may be used in

  • My medico legal report  
  • For  teaching purposes when shown to other doctors without my name

Signed……………………                        Date………………………….

I confirm that I have fully explained the implication of this permission to the patient
Signed by the doctor                         Date…………………….."