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.
 *
This is a required field.

To search a medical facility, type a postal code or the location name. Scroll to the bottom of the results to select "Funeral Home" or "House/Home/Hospice" locations. After searching, if your medical facility is not found, please click the button below to create a new delivery location.


If you cannot find the hospital you are looking for, please input the name and address in the fields below.
This is a required field.
This is a required field.
This is a required field.
This is a required field.
 *
This is a required field.
 *
This is a required field.
Invalid email! Please enter email in "example@example.com" format.
 *
This is a required field.

Baby

 *
This is a required field.
 *
This is a required field.

Parents

Parent 1

This is a required field.
This is a required field.
Invalid email! Please enter email in "example@example.com" format.

Parent 2

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

Contact Info

This is a required field.
 *
This is a required field.

Image Upload

 *
Images
Submit no more than 20 images for retouching. NILMDTS will not be able to complete requests with more than 20 images. All images MUST be submitted in a high-resolution form however should be less than 20 MB. 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.

Parent Consent, Authorization, and Release

Authorization to Photograph or Retouch Photographs. I am the parent and legal guardian of my child(ren) listed, have the authority to enter into this agreement and authorize the Affiliated Photographer or Medical Affiliate to photograph my child(ren) or authorize NILMDTS to retouch photographs of my child(ren), whichever is applicable. Alternatively, due to the parent’s inability to authorize at the time of the session, I have the authority to enter into this agreement on their behalf.
Personal Use of Photographs. NILMDTS holds the copyright of images taken (Affiliated Photography) or of the edited product (Medical Affiliates and Retouching), and in both cases are licensed to parents for personal use. I understand that the images I receive may not be used for commercial use, public media, or promotions of other nonprofits or causes without specific written permission from NILMDTS Headquarters. I agree to contact NILMDTS to obtain permission and information about proper acknowledgment.
Standard Gift. I understand that NILMDTS provides the free gift of professional quality portraiture as well as retouching services. Digital images will be professionally retouched in black and white or sepia to create an heirloom-quality portrait. I understand I will receive a digital set of images within 12-18 weeks which will allow me to have the photographs printed, at my own cost, by any photo lab. NILMDTS will not provide the originals, non-retouched, or color images per agency policies and guidelines. I understand that I am encouraged to take my own photos during and after the session.
Release. I release and forever discharge NILMDTS, the photographer, the hospital and their agents, employees, officers, directors, and representatives from all past, present, and future legal claims, actions, causes of action, damages, costs, and expenses that in any way grow out of, or are related to, the taking of photographs and their use of photographs and their use by NILMDTS or the Affiliated Photographer.
Indemnification. If any person not signing this form brings a claim against NILMDTS or the photographer that is related to the photography of my child(ren), the released matters set forth above, or the use the photographs thereafter, I will indemnify and save and hold NILMDTS and the photographer harmless from any damages incurred as a result of those claims.
Electronic Transmission of Data. By signing this release, you authorize the NILMDTS Medical Affiliate, medical provider, and/or facility to electronically transmit photographs and this consent form, which may, intentionally or unintentionally, include protected health information and other data related to the individuals named on this consent form.
(Optional) NILMDTS Use of Images Permitted. I permit the digital images and photographs of my child(ren) to be used by NILMDTS and/or the photographer for internal NILMDTS volunteer training or hospital education. For such usage, NILMDTS or the photographer may make additional copies of the photographs without my prior approval.
This is a required field.

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 12-18 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.

Images will be delivered via a secured email system.
You will receive your image gallery and occasional NILMDTS communications (you can unsubscribe anytime; we value your privacy).

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