This depends on the form you're using and where the patient was created.
Only forms designed to create a new patient (that have "Show on Main Screen" option turned to YES) should transfer the photo to the patient picture. These forms do not update information for the already created patient (including photo). You can read more about this option HERE.
Our forms are used differently for our integrated and non-integrated accounts. Our non-integrated accounts will use the forms to create a hospitalization for a patient, and the photo will indeed update within Smart Flow direct from the form.
For clients using these forms with an integrated EMR, they will still have the photo field included on the form, but when the photo of the patient is taken it is NOT updating the photo within Smart Flow. Therefore, if the owner takes a photo in the waiting room the hospital staff will need to take another one out the back. In these cases you may wish to turn off the photo field on your forms so that the photo of the patient is just taken once the patient is out the back.