Hospital Safety Innovation Filming Consent Form
Please review and complete this form to provide your informed consent for participation in filming related to hospital safety innovation activities.
Full Name
*
First Name
Last Name
Email Address
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example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Your Role or Relationship to the Hospital
*
Please Select
Staff Member
Patient
Visitor
Other
Project Description: Hospital Safety Innovation Filming
By signing below, I confirm that I have read and understood the information provided above and consent to being filmed for hospital safety innovation purposes.
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Submit Consent
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