I hereby grant permission to Alchemy Aesthetics Co. and its representatives to take and use clinical photographs and/or video recordings of me taken before, during, and after my treatment or procedure for the purposes of education, marketing, and documentation.

I understand and agree to the following:

• These materials may be used in digital and print marketing, including but not limited to: social media, email campaigns, educational materials, website content, presentations, and other promotional outlets.

• My identity will remain confidential. Unless I give separate written permission, my name, or other personally identifying details will not be used in any published material.

• I waive the right to inspect or approve the final product, including written or electronic copy, wherein my likeness appears.

• I waive all rights to compensation or ownership for the use of any such images or videos.

• I understand this release is irrevocable and may not be withdrawn once content is published or distributed.

• I release and hold harmless Alchemy Aesthetics Co., its staff, representatives, and affiliates from any and all liability in connection with the use of such materials.

By signing below, I confirm that I am at least 18 years of age and have read, fully understand, and voluntarily accept the terms outlined in this Photo & Video Release.

By submitting this form electronically, I acknowledge that this digital signature has the same legal effect as a handwritten signature. I confirm that I am the individual named above and have the legal authority to provide this consent. I understand that this form and my digital signature may be retained by Alchemy Aesthetics Co. as part of my treatment record.

By submitting this form I agree to receive marketing email and text messages from Alchemy Aesthetics Co.