Patient Consent Form
Recording of a Consultation for Training
Patient name: ___________________________
Date: ___________________________
Doctor / Student name: ___________________________
Practice: ___________________________
- We would like to record video of your consultation.
- This is for training purposes.
- Intimate examinations will not be recorded and the recording will be stopped if requested.
- The recording will only be retained while educationally useful, then deleted.
- You have the right to withdraw consent at any time by contacting the practice. The recording will then be deleted.
- The doctor may share the recording with colleagues who can provide them with educational feedback.
- If a mobile device is used to make the recording, it will be securely uploaded after the consultation and removed from the device.
- The recording may be analysed using secure Artificial Intelligence tools to support the doctor's learning. The recording and any data will remain confidential.
I have read and understood the above and consent to my consultation being recorded under these terms.
I consent to the use of AI tools: Yes / No
BEFORE CONSULTATION
Signature: ___________________________ Date: ___________________________
AFTER CONSULTATION
Signature: ___________________________ Date: ___________________________