Permission for your filmed footage to be used

Thank you for giving your time to be interviewed on camera by the PHA UK. Please complete the short form below to confirm you are happy for the footage to be used.

Filmed interview consent form

Please check the box below
I give full consent for my filmed interview 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 or calling 01709 761450