Consent form for adults sharing their story

We use real stories from Hospice patients and their families to help explain our work to the public and encourage people to support us as a charity. By completing this form, you’re giving us permission to share your story in our communications for the next year, along with any photos or videos you provide, or that we create. You can withdraw your consent at any time.

I understand the following:

  • My story and any photos or videos of me will be stored securely by Willen Hospice.
  • These could be used in printed communications (such as fundraising appeals, supporter magazines or adverts), online (such as our website and social media channels) or in the press (such as local newspapers).
  • My story will be used accurately and honestly, and never taken out of context.
  • By signing, I am confirming that anyone else mentioned in my story, or featured in my photos/videos, knows they are being included and understands these will be published publicly.
  • My story will be used for one year and then archived, unless Willen Hospice contact me to arrange otherwise.
  • I can withdraw my consent at any time during that year by contacting or 01908 306695, and my story and any photos or videos of me will be removed from circulation wherever possible.
Your name(Required)
You can choose to have your real first name published with your story or remain anonymous.

Data protection
We need to collect your personal data so that we can get in touch with you to discuss your story and/or image use.  We promise to look after the information you give us, and it will only be used for this purpose. If you would like to know how we collect, process and store your personal information, our Privacy Notice is available on our website at

In a typical year...
our cost, per minute
phone calls to patients at home
fabulous volunteers
patients cared for at home
home visits
patients at the hospice
of cups of tea
counselling sessions
We can only provide the care we do thanks to the incredible generosity of our community, through their continued volunteering, fundraising and donations throughout the year. Your donation will enable us to continue providing care and support to those facing a life-limiting diagnosis, and to support their loved ones.