Social Media Consent and Release Form

Healthy Hearts Home Living may occasionally share photos, videos, testimonials, stories, or community updates to highlight our work and supportive living environment. This form allows you to give or deny permission for your image, name, story, or experience to be used for website, social media, printed materials, or promotional purposes. Your choice is voluntary, and you may choose not to give consent.

Participant Full Name

Date of Birth

Phone Number

Email Address

Do you give Healthy Hearts Home Living permission to use your photo, video, story, testimonial, or experience?

Yes, I give permission

No, I do not give permission

Name Usage Preference

My full name may be used

Only my first name may be used

I prefer that no name be used

Consent Acknowledgement

I understand that my consent is voluntary and that Healthy Hearts Home Living may use approved photos, videos, stories, testimonials, or experiences for website, social media, printed materials, or promotional purposes.

Right to Revoke Consent Acknowledgement

I understand that I may request to revoke this consent in writing, but content already published may not be immediately removed from all locations.

Participant Signature / Typed Name

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Signature Date