1. Recording for clinical care
Speech and Language Therapy Service
Consent (Form A)
Recording for clinical care
It is ok for you to take a  
Video  
Photograph  
Recording of my voice  
I understand the recording is for my health care
Other images labelled for re-use found using
Version 31 October 2012

2.    I understand The recording will be kept safe
At any time I can say
Do not use the recording
Do not keep the recording
It will be destroyed when it is not needed  
Signature:
Print Name:
Signature of Carer/Parent/Guardian
Name of Carer/Parent/Guardian:
Therapist: Date:
Therapist please note any AAC support used to gain consent:   
This form will be kept in my health notes.
The therapist gave me a copy (please tick)