Photography Request Form

Photography request form

Please complete the form below, required fields = *

Start time and date requested for photo session*

: HH

MM
End time*

: HH

MM
Date of Session*
Location of assignment*
Please provide address and directions to location
Staff Member requesting*
Email*
Enter Email Confirm Email
Phone*
Format (###)###-###
On date of request: To be present (yes/no)?*
- yes
- no
Photo subject(s)*
Name (please note, if more than one subject, please name them in the description filed):
*
Title:
*
College and department:
*
Contact number:
Email*
Project Name/Story slug*
One to two words
Project Details*
Description of your photography project including intended audiences and types of medium images will be reproduced in. If you have a desired “look” or an idea for your photography project please include links to sample images with photo request.
Project Keywords*
Please enter relevant keywords separated by commas.
PHI Consent Information*
Enter PHI consent information: Treating physician, service line/campaign name/news story, staff member obtaining consent, etc...
What is the Purpose of Sharing the PHI? Check all that apply*
Check all boxes for the appropriate uses of these photos, and then remember to check off all boxes when having the PHI form signed by the patient. (As many as possible so that photos can be used for multiple purposes.)
- Select All
- Marketing
- News Media
- Public Relations
- Publication (e.g., brochure, online journal, book)
- Fundraising
- Not Applicable
Name of Intended publication(s)*
Please list the publication(s) this photo is intended for
These photos are ONLY for my specific campaign/project and not available to others for future use.*
- Yes
- No
Designer Assigned*
Please indicated designer working on this project.
Publication deadline*
Cutline for photo
Story summary
Slide show/Multimedia requested*
- yes
- no

Creative Services

UF Health Communications

Photography Request Form

Photography request form