The American Board of Family Medicine (ABFM) would like to invite you to participate in our Higher Standard campaign at FMX to support the specialty of family medicine and your commitment to board certification.

This campaign is part of a larger initiative that aims to increase awareness, understanding, and appreciation for the more than 100,000 diverse, board-certified family physicians. We believe this is the first step to help position board-certified physicians as leaders in their community and further enhance their credibility through authentic representation. Visit our website to view the current ABFM Board Certified physicians being featured.

Below are some examples of how images could be used and where they may be placed. 

- An in-focus headshot with testimonial on the homepage of ABFM’s public website. 
- A blurred/out of focus situational photo on informational pages of ABFM’s public website. 
- Informational flyers with situational photos supporting a topic (ex: residents featured on a “Become Certified” flyer). 
- Blurred/out of focus situational photos used as backgrounds on chapter meeting banners.

- Situational photo for informational social media posts.
 
The likeness of a physician will never be used without a signed consent form and prior vetting. If/When your photo is used, you will be notified by ABFM.

By signing this form, I hereby authorize the American Board of Family Medicine, Inc., and its affiliates, the ABFM Foundation, Inc., and the Pisacano Leadership Foundation (collectively “ABFM”), and its employees and agents to photograph or interview me and to record and/or videotape the interview. I hereby consent to the use of the photographs and video and/or audio recordings by ABFM, with or without my name and any comments I may have made at the time they were taken, as described below. I authorize ABFM to edit, copy, distribute and publish the photographs and audio and/or video recordings in accordance with the terms of this consent.

This authorization and consent include the intended use by ABFM of my name; photograph; video or audio recordings of my interview, in whole or in part; transcribed statements from my interview, and/or biographical information in one or more of the following publications and ABFM materials:

(1) ABFM, ABFM Foundation, PRIME Registry and The Center for Professionalism & Value in Health Care websites and social media (including, but not limited to, twitter, LinkedIn, Facebook, and YouTube and Instagram);

(2) ABFM, Center for Professionalism & Value in Health Care, or PRIME Registry newsletters and press releases.

(3) ABFM’s newsletter, The Phoenix, and Diplomate stories.

(4) Printed materials and other appropriate presentations, including those made available online or electronically, provided to ABFM Diplomates, candidates for ABFM certification, or those seeking to become board-certified, including resident physicians, and those seeking enrollment in the PRIME Registry;
Promotional materials for ABFM, Center for Professionalism & Value in Health Care, and/or the PRIME Registry.

(5) Conferences and/or presentations hosted by or presented by ABFM.

I understand that all uses by ABFM will be in furtherance of ABFM’s mission and purpose, including educational, informational, promotional, and outreach purposes. Should I wish to withdraw my consent at any time I will advise ABFM in writing and send to their email address www.media@theabfm.org or to their mailing address at The American Board of Family Medicine 1648 McGrathiana Parkway, Suite 550, Lexington Kentucky 40511 attention: ABFM Communications.

By signing below, I agree that I have read this authorization and consent and understand its contents.