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Consent for an AI smile illustration

Practice: ______________________________________

Our team would like to take a photo of your smile and use Odentri, a service our practice uses, to create an illustration of how cosmetic dental treatment might change your smile.

What you should know

• The illustration is created by artificial intelligence. It is a visual aid for our conversation, not a diagnosis, treatment plan or prediction of results.
• Your photo is processed by Odentri on our behalf. Part of this processing happens in the United States, where the information may be accessible to authorities under local law.
• Your photo and illustrations are stored privately and deleted automatically within 30 days, or sooner if our practice chooses. Only our team, and Odentri when needed for support or security, can access them. They are never used to train AI models, sold or used for advertising.
• Taking part is optional and does not affect your care. You can withdraw your consent at any time by telling us, and we will delete the photo and illustrations.
• We will not use your photo or illustration for anything else, such as marketing or social media, unless you give separate written consent.

Consent

☐ I agree to the practice taking my photo and processing it with Odentri to create and refine illustrative smile previews, as described above.

☐ Optional: I agree to the practice keeping a copy of my photo and illustration in my dental record.

Questions about how Odentri handles information: info@odentri.com · odentri.com/privacy