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Address * REQUIRED

Your consent

It has been explained to me and I understand that my photo, film, interview or personal story will be used by Gloucestershire Health and Care NHS Foundation Trust. I understand that my photo, story, interview or film may be used in the public domain in a variety of ways including through websites and social media, and in Trust publications, such as leaflets, newsletters, posters, and reports or training sessions. The material may also be uploaded to the cloud for editing purposes. Refusal to consent will in no way affect clinical care. Neither the Trust nor the person in the photograph/film or story will profit from the use of any materials. * REQUIRED
I consent to use of my story, photo, film or other material to be used by the NHS in the way described above. * REQUIRED
I understand the material will be retained indefinitely and used by Gloucestershire Health and Care NHS Foundation Trust and that if I wish to withdraw my consent, I can ring 0300 421 7145 and ask for the Communications Team or email ghccomms@ghc.nhs.uk at any time. * REQUIRED