Media Consent Form

Thank you for registering with NeuroMotif! We are so excited to have you join us.

Teachers and therapists at NeuroMotif sometimes collect media (photo, video, audio recordings) of students or clients to share privately with trainees or supervisors for clinical and educational review. They may also share this media privately with you to show progress updates and treatment planning.

With your permission only, the media may also be used for marketing and social media to illustrate to the public the benefits and techniques of music therapy or music instruction. You are not obligated to give permission, but we keep your preferences on file for reference so that we can proceed accordingly.

Names or any identifying information of participants, whether clients or parents, will not be shared publicly. Any collected video, audio, or photo material will be stored securely in our HIPAA protected drive.

Please indicate whether you are comfortable giving us permission to share photos, videos, audio recordings, etc., for marketing, promotion, and social media.