Retouching Request

Retouching Request:

Medical Affiliates: This form is for UNAFFILIATED Medical and Family only. If you are a NILMDTS Medical Affiliate, please log in to submit a retouching session. We encourage any currently UNAFFILIATED medical providers to learn more about our Medical Affiliation Program to become affiliated as well as earn contact hours.

Delivery Location *

Location
To search a location, please type valid postal code or begin typing the location name.

This is a required field.

If you cannot find the hospital you are looking for, please input its name and address in the fields below.
Location Name

This is a required field.

Address Line 1

This is a required field.

Address Line 2

City

This is a required field.

State

Zip/Postal Code

Country

This is a required field.

Submitted By

Unaffiliated Hospital Staff Name *

This is a required field.

Unaffiliated Hospital Staff Email *

This is a required field.

Invalid email! Please enter email in "example@example.com" format.

Baby Delivery Date *

This is a required field.

Gestation Age

Birth Type

Notes About Session

Baby:

First Name(s) *

This is a required field.

Last Name *

This is a required field.

Gender

Ethnicity

Parents:

Parent 1

Full Name *

This is a required field.

Phone 1 *

This is a required field.

Parent 2

Full Name

Phone 2

Contact Info

Country

Address *

This is a required field.

City

State

Zip/Postal Code

Parent Email *

Invalid email! Please enter email in "example@example.com" format.

Newsletter Opt-In

Partner Email

Invalid email! Please enter email in "example@example.com" format.

Newsletter Opt-In

Consent Form & Images:

Consent Form * Parent consent forms are required for each session. Please download the Retouching Consent Form then scan or photograph the signed form and upload here.

Before submitting images, back them up on your computer, the cloud, on a disk and/or memory card for your records.

Original Images *

Images

Submit no more than 30 images for retouching. NILMDTS will not be able to complete requests with more than 30 images. All images MUST be submitted in a high-resolution form. Duplicate or extremely similar poses will be discarded and out of focus images will be retouched to the best they can however some may not be able to be retouched.

Check if image use is permitted (per consent form section 8)

Retouching Request Submission Review

Please review this entire form before you submit. Make sure ALL fields with a star ( * ) are filled out and that contact numbers and email addresses do not contain errors. Upon receipt of this submission you will receive a confirmation email. If you do not receive submission confirmation, please check your spam or other filtered folders then contact us. It may take up to 6-12 weeks for retouching.If you need 1-3 images rushed for an upcoming memorial service, please email us with the baby's name and we will do our best to accommodate your request.

Did you have a NILMDTS photography session or have you previously requested retouching services for this baby? *

Yes No

Please consider making a donation to support this additional request.

Are these the only photographs you have of your baby *

Yes No

Note: Please click Save only once. If uploading large images, it may take up to 5 minutes. Please be patient.