Photo Consent

View the photo consent form in PDF… click here.

I, the undersigned, do hereby agree to the following. I am allowing Dr. Milstein or a staff member to take photos of my treatment and/or treated areas to be used for the purpose of monitoring my progress, education and/or advertising.

• At my request, my identity will remain anonymous.
  Please initial if you would like your photos to remain anonymous.
• Name
  FirstLast
• Online Signiture
• Date
  Format 00/00/0000
• File