Social Media User Generated Content Authorization Form

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

By signing and submitting this form, I give permission to HFHS to use and disclose my user generated social medial content on HFHS al social media platforms (Facebook, Twitter, Instagram etc.).

I understand that:

  • No one will be paid for use or disclosure of my user generated content. 
  • If I change my mind about allowing HFHS to use this specific content, I must tell HFHS by XXXXXXXX????
  • Even if I change my mind, HFHS cannot undo use and disclosure of my user generated content 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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