I, the undersigned, hereby consent to the use of photographs, video recordings, and other digital media of myself (or my minor child, if applicable) and authorize Universal Community Health Center use for the purposes outlined below.
Purpose of Use
The photographs, videos, and other media may be used for the following purposes:
- Educational materials
- Health center marketing and promotions
- Social media posts; website
- Training and development purposes
- Research and publication in medical journals
- Patient Testimonials and interviews
I understand that my identity may or may not be disclosed in connection with the use. I understand that I will not receive financial compensation for the use of the media. I have read and understood the above information and agree to the use of photographs, videos, and other digital media as described. I understand that all productions shall be the property of Universal Community Health Center.