Consent to publish images, video and text

This consent form should be read alongside the project ethical statement. There are two parts: consenting to being part of the project and releasing your images for exhibition or publication.

Images, video and text from this project will be used by members of the research team, led by Dame Clare Gerada and Dr Morris Gallagher, to communicate o line, in gallery spaces and in publications about the views of GPs working during the Covid 19 pandemic. 

‘I understand that photos of me and/or my likeness may be used in a public setting and displayed indefinitely. I give permission for the research team to use my likeness for research, display, and promotional purposes surrounding this project.’ 

My Name 

__________________________

Signature 

__________________________

Date

__________________________

Limitations to my consent

These are the limits of my consent (they may be about using a pseudonym instead of your real name, or something else).

_________________________________________________________

If you change your mind at any time, please contact the GP Photovoice group facilitator. 

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