Photo/Media Consent Form – Under 18s

I understand that the photo/video/audio recording to which I have agreed may be reproduced to illustrate, share and promote the work of Birmingham and Solihull Mental Health NHS Foundation Trust (BSMHFT).

By signing, or verbally consenting to this form, I understand:

• a member of my care team will review my clinical record to make sure I’m suitable for participation in the communication campaign
• if required, my responsible clinician will be asked to approve my participation in the communication campaign.

I understand that I can withdraw my consent for the use of my photo/video/audio recording at any time by emailing bsmhft.commsteam@nhs.net or writing to: Communications Team, Birmingham and Solihull Mental Health NHS Foundation Trust, Uffculme Centre, 52 Queensbridge Road, Moseley, Birmingham, B13 8QY. On receipt of my direction to withdraw my consent, BSMHFT will delete copies of my photo/video/audio from the image library, and I understand my image will not be used for future publications.

Note: Withdrawing your consent will not apply to material already published as BSMHFT cannot control or recall published material (for example printed materials and social media).

All photos/videos/audio recordings will be held on file for a period of three years*. These files are held securely on our Trust systems and are only accessible by appropriate members of staff.

*After three years the original photos/videos/audio recordings will be deleted. Note: BSMHFT cannot control or recall published material (for example printed materials and social media)