Clinical Photography

Company

This field is for validation purposes and should be left unchanged.

We have implemented new systems to allow patients to consult with Doctors without having to come to the surgery.

If you have a medical concern that it would be appropriate for a Doctor to see a picture of you will be directed here to upload your picture/s.

Please note that you must only upload photos if you have been requested to do so by either the GP or a member of the adminsitration team.

Please ensure you follow these instructions:

Where possible use a ruler, tape or coin next to the condition to help scale and focus
Provide 2-3 photos at different angles to allow the Doctor a full range of views
Ensure that the photos are in focus and clearly identify what needs to be discussed

We require your consent to add any photos you send in to your medical records, by completing this form and submitting your request, you are conseting for us to do this for you.

Please note, all photos are deleted from the holding folder once they are uploaded to your medical record.

Name

First Last

Address

Street Address Address Line 2 Postcode

Date of Birth

Who has requested you send in photos?*

Please provide details about the condition here

Photo upload*

Drop files here or

Max. file size: 128 MB, Max. files: 5.

Ensure the photos you upload are clear and that you have followed the guidelines mentioned above. Please note, we are not able at accept photos of any areas that would be deemed a "Private" area, e.g genitals, breasts etc

Consent*

By choosing YES below, you are consenting to the photos you upload being added to your medical record. You are also confirming that the photos you have submitted are not of what would be considered a "Private Area" and you are happy for them to be processed for the reasons of your clinical care.

Yes

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Waddesdon Surgery

Clinical Photography