Photo Release Form

S.S.I. Photo Release Agreement submission & upload form

This legally binding form may be accessed only by the proper password being entered below. This password protection is used in order to prevent spam uploads/submissions.

Note: As this form may be used for multiple purposes, please contact Therapist Samantha Summers for details.

IF YOU HAVE NOT BEEN INSTRUCTED OTHERWISE, YOU MAY OBTAIN ACCESS TO THIS FORM FOR ONLY $2.00 HERE: 

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