Massachusetts State Seal An official website of the Commonwealth of Massachusetts Here's how you know

Official websites use .mass.gov

A .mass.gov website belongs to an official government organization in Massachusetts.

Secure websites use HTTPS

A lock icon or https:// means you've safely connected to the official website. Share sensitive information only on official, secure websites.

DDS Photo/Video Release Guidance

Consent form for the use of photographic or video images taken of individuals served by DDS

DDS provides a Photo/Video Release template that individuals (or their guardians) may use to provide consent for photographs or video. The template is intended to align with 115 CMR 5.04(2) and support individuals’ rights related to privacy and protection from private and commercial exploitation.

Disclaimer: This template does not constitute legal advice. Providers are encouraged to consult independent legal counsel before using this form or any other photo/video release form.

Help Us Improve Mass.gov  with your feedback

Please do not include personal or contact information.
Feedback