top of page

Optional Marketing Authorization

This authorization is voluntary. Declining will not affect your eligibility for services, pricing, or quality of care. It is separate from your procedure consent and confidential treatment documentation consent.

Your choice: I decline marketing use of my images / I authorize only selected uses
I decline marketing use of my images.
I authorize only the marketing uses selected below.

Unchecked options are not authorized. If neither choice is selected, no marketing permission is granted.

Images Authorized - Select all that apply.

Before and after photographs of the treatment area only
Authorize
Do not authorize
Photographs showing my full face
Authorize
Do not authorize
Video showing treatment area only without voice
Authorize
Do not authorize
Video showing my face and/or including my voice
Authorize
Do not authorize
Contours Beauty Ink website
Authorize
Do not authorize
Contours Beauty Ink social media accounts
Authorize
Do not authorize
Paid online or social media advertisements
Authorize
Do not authorize
Printed brochures, flyers or studio displays
Authorize
Do not authorize
Name and Identification - Select one
Do not publish my name, social media handle, or tag my account.
First name only may be used.
My account may be tagged.

Even without my name, facial features or other distinctive characteristics may make me recognizable.

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.
bottom of page