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Media Consent Form

Please read our Media Consent Form carefully before agreeing to its terms. This form contains information related to the use of your story, photographs and other information you provide to Children's. By selecting the "I Agree" button below, you acknowledge that you understand and agree to be bound by the terms set forth in this form.

General Consent
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Birthday of Patient or Minor
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The above name serves as signature for consent form.
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Consent Agreement
Type of consent:

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To revoke consent for any reason, send request along with the patient's or minor's full names and birthday to mediaconsents@choa.org or 1699 Tullie Circle NE, Atlanta, GA 30329.