Social Media Release Form Please enable JavaScript in your browser to complete this form.Name *FirstLastDate / TimeConditionsI grant Miracle Life Chiropractic permission to use my image and/or video for promotional purposes, including but not limited to social media platforms, the clinic’s website, print materials, and other digital or physical marketing efforts. I understand that: – Use of Content: My image and video may be featured in educational, promotional, or informational materials that highlight chiropractic care, patient experiences, and clinic services. – Privacy: No personal health information beyond what I provide will be disclosed. – Duration of Consent: – This permission remains valid unless I choose to revoke it in writing. – If I withdraw consent, Miracle Life Chiropractic will stop using my content in future publications, though previously published materials may remain. – Content Modifications: Miracle Life Chiropractic may edit, crop, or modify images and videos for clarity or branding purposes but will not alter their intent or meaning. – No Compensation: I understand that I will not receive financial compensation for the use of my content in promotional materials. – Participation is Completely Optional: I understand that signing this form is entirely my choice, and whether I participate or not, my experience at Miracle Life Chiropractic will always be welcoming, supportive, and focused on my health and well-being. to Date Be Would I Like to Be on Camera?YesNoSubmit