Consent forms are required when photographs or recordings are taken of staff, service users and patients. This is in adherence to the General Data Protection Regulation Act 2018, which protects people’s data and the right to not have an image taken and or published without their written consent.

A copy of this consent form will be sent to communications@mereycare.nhs.uk and to the email address you provide on the final question.

Required
Address Required
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Required
Required
Required
Please tick the below boxes to confirm that you are happy with your image to be used for: Required

Privacy Notice

I understand that still and moving images and audio will be stored electronically in accordance with the Data Protection Act and may be used for up to six years from the date of signing. For additional information please read our Privacy Notice on the About Us pages of the website www.merseycare.nhs.uk/about-us/privacy

I have the right to withdraw consent at any time (note that we may not be able to withdraw all printed materials from circulation) by contacting the Communications Department, Mersey Care NHS Foundation Trust, Portakabin, Hollins Park site, Hollins Lane, Winwick, Warrington, WA2 8WA.

Required

Consent

I am the person identified above and in the photograph(s), filming and/or recording.

I am the witness for the person identified above and in the photograph(s), filming and/or recording.

Please ask a witness to sign where additional consent is needed to confirm it’s in the person’s best interest to be involved.

If the person is younger than 18, a parent or guardian will need to provide consent as a witness.

Digital copy of consent

Required
Required
Download a paper copy of the consent form