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Information consent form

By completing the form below, you grant Queensland Eye Institute Foundation (QEIF) your permission to use photos, video and/or audio recordings of you in QEIF marketing activities, including documents, promotional materials, websites and social media publications.

Photos and videos (now referred to as images) and/or audio recordings or other personal information described in this form may be supplied to QEIF staff, contractors or service providers (eg graphic designers) engaged by QEIF to produce marketing materials but will not be provided to any other person or organisation for purposes other than described.

QEIF will store your images digitally in its photographic library database. A copy of your signed information release authority will be filed with your images. Once stored in the database, your images may be used by QEIF for a wide variety of purposes, ongoing, until advised otherwise by you in writing.

Any images and other personal information will be stored, used and disclosed in accordance with the requirements of the Privacy Act 1988 (Clth). The QEI Privacy Policy can be viewed here: QEIF Privacy Policy. To request images be removed from the database please telephone or email QEIF using the contact details listed on our website here: Contact QEIF

Information release authorisation

Permission to use name, images and audio recordings

"*" indicates required fields

Name*
Date of birth*
Date of birth
Guardian name if subject is under 18 years or has impaired capacity
Email*
Consent*