Cleveland Clinic Copyright Request Form | Center for Medical Art & Photography

Thank you for directing this request on to us, so we may properly review, record & license your requested work(s).

We will provide specific documentation permitting CCF intellectual properties to be printed and or posted digitally in the formats requested.

Our documentation will grant a license to reproduce CCF works, while maintaining ownership / copyright. We reserve the right to avoid any contractual agreements that seize control / ownership of CCF intellectual properties.

Please note; this information requested below is required only after your manuscript has been formally accepted or for a book chapter/invited manuscript.

To aid us in preparing proper licensing, we need to know:

Requestor Information

Your Email: (up to 100 characters)
Your Name: (up to 100 characters)
Your Phone: (up to 20 characters)

Publisher, Author and User/Website or Project Name

Title of article, chapter, production, etc. (up to 500 characters)
Name of Book, Journal, periodic, production, etc. (up to 250 characters)
ISSN/ISBN# (if applicable): (up to 100 characters)
Name of Publisher: (up to 100 characters)
Publisher Address: (up to 100 characters)
Publisher Phone: (up to 20 characters)
Publisher Fax (if applicable): (up to 20 characters)
Editor in Chief of Publication: (up to 100 characters)
Your Contact Person at the Publication: (up to 100 characters)
Your Contact Person's email address: (up to 100 characters)
Manuscript author: (up to 100 characters)
Manuscript author's title: (up to 100 characters)
Manuscript author's department: (up to 100 characters)
Manuscript author's institute (if applicable): (up to 100 characters)
Additional Cleveland Clinic associated staff names: (up to 500 characters)

Attach files of artwork, photography so we can ascertain status and retrieve assets

Attach File (if you have multiple files please upload a Powerpoint file):
Comments (identify artist add hyperlinks to websites etc.): (up to 500 characters)

Supplying this info will streamline the process and will expedite the handling of your request.

Please note; external requests without CCF co-authorship may result in a licensing fee / per figure being charged. See attached licensing fee schedule

Licensing Fee Schedule:

CMAP/CCF required fee(s) 5x7 inch 8x10 or Cover
Web/electronic (96 PPI) $ 60.00 $ 180.00
Print (300 PPI, RGB Tiff) $ 100.00 $ 300.00
Print & electronic combo $ 150.00 $ 450.00

Fees may be waived with CCF Staff approval when requested by Non-Profit Organizations and or Non-Medicare /Medicaid programs