Consent to Share Personal Story and Images
I, the undersigned, hereby give my voluntary consent to the North Carolina Center for Reproductive Medicine (NCCRM) to share my personal story regarding my fertility journey and the care I received as a patient of NCCRM, including the outcome of a successful pregnancy.
I understand that this may include written details I have provided, as well as images that I submit to NCCRM. I authorize NCCRM to use this content across a variety of platforms, including but not limited to:
Social media channels (e.g., Facebook, Instagram, X/Twitter, YouTube, TikTok)
NCCRM’s official website, blog, email newsletters, and marketing communications. Printed materials or digital content displayed in the office (e.g., display boards, monitors)
I understand that my participation is entirely voluntary and that I may revoke this authorization at any time by submitting a written request to NCCRM. I acknowledge that any revocation will not apply to materials that have already been published before the receipt of my written notice.
I also understand that once my story and/or images are shared publicly, NCCRM cannot guarantee or control how third parties may access, share, or use this information.
By signing below, I acknowledge that I have read and fully understand the terms of this consent.