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Patient Testimonial Consent Form Template for England and Wales

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Key Requirements PROMPT example:

Patient Testimonial Consent Form

"I need a Patient Testimonial Consent Form for my dental practice that specifically covers both written testimonials and before/after photos, which we plan to use on our new website launching in March 2025 and in our social media marketing."

Document background
The Patient Testimonial Consent Form is essential for healthcare providers in England and Wales who wish to collect and use patient testimonials for various purposes, including marketing, educational materials, or quality assurance. This document ensures compliance with UK data protection laws and healthcare regulations while providing clear documentation of consent. The form should be used whenever a healthcare provider wishes to collect and publish patient experiences, protecting both parties by clearly outlining the scope of consent, usage rights, and data protection measures. It's particularly important given the sensitive nature of medical information and the strict regulatory environment governing healthcare communications.
Suggested Sections

1. Patient Information: Basic details of the patient providing testimonial including name, contact information, and relevant medical context

2. Purpose Statement: Clear explanation of how the testimonial will be used, including specific platforms, audiences, and contexts

3. Consent Declaration: Express permission for use of testimonial, including acknowledgment of voluntary participation

4. Data Processing Information: Detailed explanation of how personal data will be stored, processed, and protected in compliance with UK GDPR

5. Withdrawal Rights: Clear statement of patient's right to withdraw consent at any time and process for doing so

Optional Sections

1. Image/Video Consent: Additional specific consent for use of photographs, videos, or other visual media of the patient

2. Marketing Usage: Specific consent for use of testimonial in marketing and promotional materials

3. Time Limitation: Specific duration for which the consent remains valid, if not indefinite

Suggested Schedules

1. Schedule 1 - Copy of Testimonial: Exact content of the testimonial being approved by the patient

2. Schedule 2 - Privacy Notice: Detailed information about data protection rights and privacy policies

3. Schedule 3 - Image/Media Schedule: Copies or descriptions of any photographs, videos, or other media included in the consent

Authors

Alex Denne

Head of Growth (Open Source Law) @ ¶¶Òõ¶ÌÊÓÆµ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Relevant legal definitions















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Industries

UK GDPR and Data Protection Act 2018: Primary legislation governing how personal data must be collected, processed, and stored in the UK following Brexit. Critical for handling patient personal information in testimonials.

Human Rights Act 1998: Particularly Articles 8 and 10, protecting right to privacy and family life, and freedom of expression respectively. Ensures balance between privacy rights and consent to share experiences.

Common Law Duty of Confidentiality: Legal principle requiring healthcare providers to maintain patient confidentiality. Medical information is considered confidential and requires explicit consent for sharing.

NHS Act 2006: Contains specific regulations regarding the handling and protection of patient information and confidentiality within healthcare settings.

Medical Act 1983: Sets out professional standards and ethical requirements for medical practitioners regarding patient information handling and confidentiality.

Consumer Rights Act 2015: Relevant when testimonials are used for marketing purposes, ensuring fair and transparent use of patient testimonials in promotional materials.

Healthcare Regulatory Bodies' Guidelines: Professional standards set by bodies like GMC and NMC regarding patient information handling and consent requirements for testimonials.

Marketing and Advertising Regulations (CAP Code): Guidelines governing the use of testimonials in marketing and advertising, ensuring ethical and accurate representation of patient experiences.

Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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