permission to release information

A grinning doctor and a smiling boy with braces, both with crossed arms, lean back-to-back outdoors.

This form allows families to give permission for Dayton Children’s to use photos, videos or other information for things like our website, publications, internal communications and more. It helps us share stories, moments and information that support our mission and community.

Completing the form is completely optional and no information will be shared without it begin completed and submitted to Dayton Children’s.

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Whether you’re looking for the right provider, ready to make an appointment, or need care right now—we’re here to help you take the next step with confidence.

Baby Sleeping