Digital Media Consent Form

Title: *

This is the details of the person who is being photographed

First Name: *

Surname: *

Email: *

If you do not have an email address, please complete a paper consent form.

Are you giving consent on behalf of someone you care for, or a child under 18?

By ticking this box I consent for this image/these images and/or videos to be used for Trust communications, publicity and or promotional purposes.

This includes, but is not limited to social media platforms, website content, media relations, internal news and printed literature.

e-signature box: *

You will receive confirmation of this consent by email.

To be completed by a member of CHFT staff

Description: *

Reason for photo:

Colleague Information: *

Digital Media Consent Form

Form Details

Personal Details

Consent Details

To be completed by a member of CHFT staff

Description of image or video – e.g. a patient with a nurse at a ward event

Please send a copy of the photograph to CHFT@cht.nhs.uk

Colleague information - full name and department