Image Consent Form

Please fill in this form to give consent for Healthwatch Essex to use your image for marketing purposes across a wide range of channels. Please only complete this form if you are satisfied that the purpose for which the image/footage may be used has been explained to you and you are happy for it to be used without any further approval. Any materials captured will remain the property of Healthwatch Essex.
Name(Required)
Address(Required)
This form may only be completed by those over the age of 18. Please confirm which of the below applies.(Required)
I consent to(Required)
Withdrawal of consent

You may withdraw your consent at any time by contacting us at: Healthwatch Essex, 49 High Street, Earls Colne, CO6 2QX. If you withdraw your consent, we will not use your image/footage in any new material and will delete your image from our records. However, your image/footage may be retained on existing materials where a) there is a legitimate interest for Healthwatch Essex to maintain the public availability of those materials, b) this legitimate interest is not overridden by any prejudice (damage or harm) to your own interests or fundamental rights or freedoms, and c) where it is not reasonable and proportionate in the circumstances for the publications or materials to be withdrawn. You may request the withdrawal of any publication or material containing your image, for reasons of prejudice to your own interests, fundamental rights or freedoms, by contacting us at the address above. Any such request will be considered by Healthwatch Essex and you will be informed of the outcome. All details of how your data is used and stored is available in our Privacy Policy.