Photo, film and media usage consent form

RFLPS, a wholly owned subsidiary of the Royal Free London NHS Foundation Trust, is committed to showcasing the impactful work of its people across our healthcare estate projects. From internal reports to public-facing websites and social media, we use photography, film, and media content to communicate our work and values.

This form seeks your permission to record and use your image, voice or contributions for promotional and informational purposes. All content will be used in a positive, appropriate, and respectful context, in accordance with UK law and GDPR.

How we may use your image or contribution:

RFLPS will not sell or misuse your image and will ensure any use is aligned with our purpose and values.

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

Your details*

Job title or role (if applicable)

Department/team (if applicable)

Date of filming/photography

Email address*

Phone number*

Name of parent/guardian (if under 18 or unable to consent)

Consent statements*

Please tick all boxes below to give consent

I give permission to RFLPS to use photos, films and recordings of me as stated above.

I understand this consent is indefinite unless withdrawn by contacting [email protected].

Third ChoiceI may withdraw consent at any time, though this does not apply retrospectively.

I acknowledge I have no copyright or ownership of the materials.

I understand and agree to the RFLPS privacy policy

Signature*