Surgery Photography Request Form Please complete the form below, required fields = * PLEASE NOTE: Standard delivery for photos is 3 business daysCONTACT INFORMATIONStaff Member requesting* Email* Enter Email Confirm Email Phone*Format (###)###-###Will you be present at the photoshoot (yes/no)?* yes no If no, please provide information (name, email, cell) for the contact person who will be present: Will you be responsible for the creative discussions (yes/no)?* yes no Is the person responsible for the creative discussions the same person who will be attending the photoshoot (yes/no)?* yes no If no, please provide information (name, email, cell) for the contact person who is responsible for creative discussions: Please book a call to discuss this project (Tuesdays 8:30a-10a). *Required for all Surgery projects. https://outlook-sdf.office.com/bookwithme/user/b8e2d84539cf4645847732f633e04274@ufl.edu/meetingtype/ugEe-3PGQUqFVLmE-_DTsA2?bookingcode=f67cdf74-cf5a-4bae-b660-2207b6175ee3&anonymous&ep=mlinkPROJECT INFORMATIONProject Name (aka. Slug):*2-3 words. This will be used for naming the project folders and files so you can find them later in Photoshelter. Service Line or Department needing marketing photos:* Is there an identified project that the photos are needed for? (Brochure, website, etc.)* yes no Please explain the intended use of the photos:Please list materials where the photos will be used. (Brochure, website, etc.): Is there a due date for the materials?* yes no Due date for materials: MM slash DD slash YYYY Intended Audience* Patients Faculty & Staff Community Students Other If other, please explain:* Photo Samples and/or Creative StylesIs there a specific “look” you’d like to replicate for this project. Please include link: SCHEDULINGHas a suggested shoot date already been discussed?* yes, specific date yes, date range no Date Requested* MM slash DD slash YYYY Date Range Requested* How long is the surgery expected to take and how long do you need photography coverage?* Requested Start Time* : Hours Minutes AM PM AM/PM If needed, is this date/time flexible?* yes no What is the date range or time period you are looking to schedule?* LOCATIONBuilding Name* Address*(What you would use to put into GPS) Room Number* Additional Location Information*Please provide additional directional information so we know how to find the place. (Assume we’ve never been there before.)PHI (PERSONAL HEALTH INFORMATION) CONSENT FORMSAre PHI Forms needed for this photoshoot?* yes no Staff Member Responsible for Obtaining PHI Forms* What is the Purpose of Sharing the PHI? Check all that apply*Check all appropriate uses of these photos Select All Marketing News Media Public Relations Publication (e.g., brochure, online journal, book) Fundraising Not Applicable 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.)ADDITIONAL INFORMATIONDesigner Assigned*Please indicate the designer working on this project so we can connect with them.Selena CarterMary CeceliaMadelyn HyderMichael McAleerThere will be a designer, but they are not assigned yetThere will not be a designerProject Keywords*Please enter relevant keywords separated by commas. These keywords are used in Photoshelter to assist in finding the photos using the search feature.Caption for Photos*This caption will be archived in the metadata of the image. This is 1-2 full sentences that includes: WHO, WHAT, WHEN, WHERE & WHY.Are these photos ONLY for your specific campaign/project and not available to others for future use.* Yes, these are only for my use and cannot be shared No, these images can be shared with others Besides yourself, will anyone else need access to the gallery after the photoshoot?* yes no Please provide each person's email address:
