Interview consent

Please fill in the short form below to confirm you are happy for your interview to be used by the PHA UK. If you have any questions, please email media@phauk.org.

Thank you for helping us in this extremely valuable way.

Interview consent form

Name(Required)

Date (including year)(Required)

Please check the box below

I give full consent for my interview / story, including any photography or filmed footage, to be used by the PHA UK for activities which meet its objectives of raising awareness of pulmonary hypertension and supporting people affected by the condition. I understand the interview may be used in, but not limited to, the following ways: Media releases to newspapers / other media outlets, on the PHA UK website/s, social media channels, in clinical presentations, and at events. I understand that it may be shared with media outlets and partner organisations for the purposes as outlined above. I understand that the interview may be used at any time in the future, but that I can withdraw my consent at any time by emailing office@phauk.org or calling 01709 761450