Consent form

Please read the below carefully before filling out the form.

It has been explained to me and I understand that any video / photos taken of me will be used in relation to promoting the West Suffolk NHS Foundation Trust (WSFT), illustrating patients’ and staff experiences.

I understand that all or part of the video footage / photographs may be used in conjunction with any form of illustration and text within WSFT publications, advertising, websites, social media.

If an external professional photographer/videographer is used I understand that they may use these images to promote their business.

As a result, I understand that the general public worldwide may see the video footage / photographs. I understand that once video footage or photographs are available in the public domain it will not be possible for WSFT to control the use of that material. Video footage and photographs will be retained for four years and then destroyed. They will not be used for any new publications/social media posts/advertising by WSFT but may continue to exist in areas outside of our control.

Refusal to consent will in no way affect my clinical care provided to me by the West Suffolk NHS Foundation Trust.

I hereby give my informed consent for video footage / photographs to be taken of me and used by the West Suffolk NHS Foundation Trust as set out above. I know I will not be paid for allowing the video footage / photos to be taken and used. And I am giving this consent freely and without any expectation of more or preferential treatment from the NHS because of it.

I understand that I can withdraw my consent at any time, by informing the West Suffolk NHS Foundation Trust communications team, in writing, of my wish to do: Communications Department, Flat 1 Oak House, West Suffolk Hospital, IP33 2QZ.