The Academy of Pelvic Health Physical Therapy requires documented patient permission before publishing a patient story, whether submitted directly by the patient or by an Academy member on the patient’s behalf.
Patients may choose to share their story anonymously or authorize the use of their name and selected photos, video, or audio. Before publishing any identifiable patient story, the Academy must have a completed media release signed by the patient or their legally authorized representative on file.
If you are submitting a story on a patient’s behalf, please arrange for the patient to complete the consent form. Your submission does not replace the patient’s permission. Do not submit identifiable patient information until any required authorization for disclosure to the Academy has been obtained.
Whether you are the patient or provider submitting the blog article to the Academy at www.aptapelvichealth.org/info/patient-stories, make sure to upload this signed form to your blog article submission, otherwise the blog article will not be published until this consent & release form is signed and submitted.