Parkinson's UK consent form

First name

Last name

Address line 1

Address line 2

Town or city

Postcode

Phone number

Date of birth

We'll never disclose your age without your consent, but it helps us monitor diversity within our storytellers.

Your consent preferences

Please read through the options below and select all of the ways you are happy for your content to be shared:

What is the name of the staff member at Parkinson’s UK that contacted you about this consent form?

Your restrictions and comments

Your content will not be used for any longer than 5 years. You can ask us to stop using it before then by emailing [email protected]. The consent form and any content you have shared with us will be stored on a secure system. Once your consent expires, we will either be in touch to renew it or we will archive (keep, but not use) your content and associated records for 3 years after your consent expiry date or the date you withdraw consent.

Please select each of the boxes below to indicate your explicit consent for your contact details and for your content to be stored, and shared, by Parkinson's UK in our communications:

You must request my permission each time you wish to use my content.

Please be assured that if your content is going to be used in the media or mass market advertising, you will be contacted to ensure you are happy for it to be used in this way.

If you have any other restrictions or comments, please let us know now:

Withdrawing or changing consent

You can withdraw or change your preference for the use of your content at any time. If you no longer wish to share your story or want to change how it is used, contact us at [email protected] and we will act on your decision within 30 days. It may not always be possible to withdraw materials already published or issued before you withdrew consent.

Find more information on our privacy policy on our website.

Diversity monitoring information

This part of the form is completely optional.

We are committed to a policy of equal opportunities and we welcome the sharing of lived experiences from all backgrounds. This information helps us understand the diversity of the people we work with. This information will be used to help ensure we are proactively including a range of voices in our press and marketing materials.
This information will be held in line with the Parkinson's UK privacy policy.

Parkinson’s UK may share anonymised data with our Senior Leadership team, our Equality, Diversity and Inclusion Lead, Committees and Trustees.