Media Release/Consent Forms: Photos, Video, Audio & Testimonials

Showing or quoting non-WashU people gives your message perspective. Here's how to get permission.

A media consent form is necessary to get explicit permission from any person who is not a student, faculty or staff member at Washington University whose name, likeness or words appears in your group’s communications, promotions or other media. For example, you must get their signed consent in order to use their name, likeness or words in photos, videos, audio recordings and testimonials.

Consent is not required for Washington University students, faculty and staff. As a courtesy, please advise these individuals of the purpose of the shoot or interview.

If you have any questions about the consent process, including acquiring the necessary permission for recording visiting speakers and lecturers, please contact us.

Patients

Use the online HIPAA media release form. All information is stored on secure server.
Updated 3/1/23

Tips for using the online HIPAA form

WashU employee starts the process:

  1. Log in and select Fill Out New Consent Form.
  2. Leave BJC checked. Also check Washington University, as well as the hospital location, and any other hospitals that reasonably might use the patient’s likeness or content.
  3. Describe the project (Ex: The audience is a general public audience via print, digital and broadcast).
  4. Fill out the patient information fields that employee has access to (name, birthdate, contact, etc.).
  5. Click Submit – this will email the patient.

Patient receives email and completes information:

  1. Open the email initiated above (may go to junk folder) and follow the link within 72 hours of receipt.
  2. Fill out the form.
  3. Click Submit – this emails employee who initiated the process.

WashU employee finalizes within 72 hours:

  • Finalize the authorization within 72 hours by following the emailed link or logging in and clicking Search Existing Consent Form.

If the patient does not have an email address or if consent is needed in a location without Internet connectivity, use this printable PDF:
Patient/HIPAA media release form (PDF)

Non-patients (including models posing as patients and visiting speakers or lecturers)

If the communication is unrelated to clinical care, use this general media release form.

Media release form (PDF)
Updated 5/1/14

For minors/children: Media release form (PDF)
Updated 1/20/16