Social Media User Generated Content Authorization Form

Thank you for agreeing to share your social media content on Henry Ford Health social media platforms. Please complete the information below and sign this form.

By signing and submitting this form, I give permission to Henry Ford Health to use and disclose my user generated social media (UGC) content on all Henry Ford Health social media platforms (Facebook, Twitter, Instagram, LinkedIn etc.).

This UGC can be used for promotional purposes.

I understand that:

  • I will not be paid for use or disclosure of my UGC.
  • If I change my mind about allowing Henry Ford Health to use this specific content, I must send an email to the Henry Ford Health Social Media Team (Henry Ford [email protected]).
  • Even if I change my mind, Henry Ford Health cannot undo use and disclosure of my UGC that has already happened.

* Asterisk indicates required field.

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If authorizing use of content that involves a minor, please list the minor’s information below:
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Electronic Signature
Patient / Personal Representative /Parent or Legal Guardian. For minors 17 and under, a parent or legal guardian’s signature is required.
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By signing and submitting this form, I give permission to HFHS to use and disclose my user generated social media (UGC) content on all HFHS social media platforms (Facebook, Twitter, Instagram etc.).
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