Lactation Consultant Media Release Form

Our Lactation Consultant Media Release Form is a professional, customizable document designed to protect both lactation consultants and their clients when sharing photos, videos, or audio recordings related to breastfeeding and lactation care services. This form ensures that informed, written consent is obtained from clients before any media is used for promotional, educational, or documentation purposes across websites, social media, or other platforms.

By setting clear expectations, this form helps foster trust and professionalism between lactation consultants and their clients while safeguarding privacy and honoring client preferences.

Key Sections of the Lactation Consultant Media Release Form:

Client and Consultant Information:
Collects essential contact details for both the lactation consultant and the client to clearly identify all parties involved in the agreement.

Purpose of Media Use:
Outlines the specific types of media use—such as social media content, website promotion, educational materials, or digital publications.

Client Consent:
Provides a clear statement of consent where the client authorizes use of their image, voice, or likeness for approved purposes.

Right to Modify and Edit Media:
Clarifies whether the lactation consultant has permission to crop, enhance, or edit the media for use in professional materials.

Confidentiality and Privacy:
Addresses the importance of client confidentiality and ensures that any shared media will be handled with sensitivity and respect.

Compensation or No Compensation:
Outlines whether the client expects compensation or is voluntarily consenting to media use without payment.

Time Period of Consent:
Defines how long the consent remains valid, ensuring clarity around duration and future usage.

Revocation of Consent:
Explains the client’s right to revoke consent at any time and the process for doing so.

Client Acknowledgment and Signature:
Includes space for client (and parent/guardian if applicable) to confirm understanding and acceptance of the terms.

Key Features:

• Professionally Written & Customizable: Easily edit in Microsoft Word to align with your business branding, services, and preferences.

• Print-Ready: Once personalized, the document is ready to print and present as a professional form.

• Email-Friendly Format: Ideal for digital communication; send via email for remote or in-office use.

• Clear Consent Terms: Written in easy-to-understand language to ensure clients fully comprehend their rights and the intended use of any shared media.

How It Works:

1. Purchase the Template – Instantly access your digital download after purchase.

2. Edit the Template – Customize it with your lactation consultant business information and specific media usage preferences.

3. Save & Use – Save the completed form to collect client signatures before using any media from your sessions.

PLEASE NOTE:

• Personal Use Only: This form is intended for use within your own business. Redistribution, resale, or forwarding of this file is strictly prohibited.

• Digital Product: This is a digital download. No physical item will be shipped.

• All Sales Are Final: Due to the nature of digital products, no refunds will be issued.

A well-crafted Lactation Consultant Media Release Form helps maintain professionalism, uphold ethical media usage, and strengthen trust with your clients. By clearly defining how media will be used and ensuring client comfort and consent, you can confidently share your work while protecting privacy and supporting positive relationships in your lactation practice.