Explicit Consent Text

Pursuant to the Turkish Personal Data Protection Law No. 6698 (“KVKK”), which entered into force on 7 April 2016, Private Altınkum Dental Oral and Dental Health Polyclinic (“Altınkum Dental” or the “Polyclinic”) attaches importance to the protection of your personal data.

Detailed information regarding the purposes for which your personal data is processed, the legal grounds for processing and the persons or organisations to whom your data may be transferred is provided in the Personal Data Protection and Privacy Notice presented to you.

Personal data that must be processed for the provision of healthcare services, creation of patient records, examination, diagnosis, treatment, care and follow-up processes, fulfilment of legal obligations and retention of records required by applicable legislation may be processed on the basis of the legal processing conditions set out under the KVKK and applicable healthcare legislation.

Where such processing does not legally require explicit consent, these activities are not conditional upon your explicit consent.

This Explicit Consent Form applies solely to personal data processing activities for which explicit consent is required as the applicable legal basis.

1. Processing of Personal Data Subject to Explicit Consent

I acknowledge that I have read the KVKK Privacy Notice provided to me and that I have been informed about the purposes for which my personal data may be processed.

To the extent that explicit consent is legally required, I state my preference regarding the processing, in a limited and proportionate manner and for the purposes described in the Privacy Notice, of:

• my contact information,
• visual and audio recordings,
• intraoral and extraoral photographs,
• images obtained before, during and after treatment,
• other personal data whose processing outside the mandatory scope of healthcare services requires explicit consent.

[ ] I consent
[ ] I do not consent

2. Use of Treatment Images for Educational and Scientific Purposes

Provided that information that directly identifies me is removed or anonymised to the extent reasonably possible, I state my preference regarding the use of my intraoral images, radiographic images and clinical photographs created during treatment for scientific meetings, professional education, case discussions or academic studies involving healthcare professionals:

[ ] I consent
[ ] I do not consent

This choice does not affect the healthcare services provided to me.

3. Use of Photographs and Videos for Promotional Purposes

I state my preference regarding the use of photographs, videos or similar visual recordings obtained during my treatment process on Altınkum Dental’s website, social media accounts, digital communication channels or promotional activities:

[ ] I consent
[ ] I do not consent

Giving consent for such use is not a condition for receiving healthcare services.

Where any visual material may directly or indirectly reveal my identity, applicable rules concerning personality rights, patient confidentiality and healthcare legislation shall also be taken into account.

4. Patient Satisfaction and Service Improvement Communications

After completion of healthcare services, I state my preference regarding being contacted by telephone, SMS, e-mail or other communication channels for the purpose of evaluating my experience and measuring patient satisfaction:

[ ] I consent
[ ] I do not consent

Where such communication qualifies as a commercial electronic message, any additional permissions required under applicable legislation shall be obtained separately.

5. Transfer of Personal Data to Third Parties

Where an activity requires explicit consent as its legal basis, I state my preference regarding the transfer of my personal data, solely for the purposes specified in the Privacy Notice, to:

• service laboratories,
• dental prosthesis or appliance manufacturers,
• technical service providers,
• other authorised service providers.

[ ] I consent
[ ] I do not consent

Transfers that may lawfully be made without explicit consent pursuant to applicable laws or other legislation are outside the scope of this preference.

6. International Transfer of Personal Data

International transfers of personal data are assessed separately in accordance with Article 9 of the KVKK.

For regular international data transfers, rather than relying solely on a general explicit consent declaration, the transfer mechanisms prescribed under the KVKK—such as an adequacy decision, appropriate safeguards, standard contractual clauses or other legally recognised mechanisms—shall be applied where appropriate.

Where an international transfer is made on an occasional basis and no adequacy decision or appropriate safeguard is available, separate explicit consent may be obtained after the data subject has been informed of the possible risks.

Accordingly, where a specific international transfer is to be based on explicit consent, separate consent shall be obtained, identifying, as appropriate, the relevant service provider, destination country, categories of personal data, purpose of transfer and potential risks.

Withdrawal of Explicit Consent

I have been informed that I may withdraw my explicit consent at any time with respect to processing activities based on explicit consent.

Withdrawal of consent shall take effect prospectively. Once the withdrawal request reaches the data controller, the relevant processing activity based solely on explicit consent shall be discontinued, subject to applicable legal obligations.

I understand that refusing to provide explicit consent, or subsequently withdrawing it, does not affect personal data processing activities that do not depend on explicit consent and are necessary for the provision of healthcare services or compliance with legal obligations.

Declaration of the Data Subject

I acknowledge and declare that I have read the Personal Data Protection and Privacy Notice, that I have been sufficiently informed regarding the processing of my personal data, and that I have indicated my preferences for each of the processing activities above of my own free will.

Full Name: ..................................................................................

Turkish ID No. / Passport No.: ..................................................................................

Date: …… / …… / 2026

Signature: ..................................................................................

Data Controller: Private Altınkum Dental Oral and Dental Health Polyclinic
Website: https://altinkumdis.com/
Address: Altınkum Dental’s official correspondence address