Death Doula Media Release Form

Our Death Doula Media Release Form is a professional, customizable document designed to support death doulas and the clients they accompany through end-of-life care. This form ensures that clear and compassionate consent is obtained before using any media including photos, videos, or recordings captured during bedside support, family meetings, rituals, legacy projects, or other moments connected to end-of-life care. It also accounts for media involving partners, relatives, support persons, or minors present. By outlining expectations with sensitivity and clarity, this form protects privacy, honors emotional boundaries, and builds trust throughout the dying and grieving process.

Key Sections of the Death Doula Media Release Form:

Client and Doula Information:
Collects essential contact information for both the doula and the client to identify all parties involved.

Purpose of Media Use:
Explains how media may be used, such as for websites, social media, marketing materials, educational content, professional training, or other media outlets.

Client Consent:
Provides a clear section where the client grants permission for the use of photos, videos, or recordings for agreed-upon purposes, including media featuring family members or minors.

Right to Modify and Edit Media:
Clarifies whether the doula may crop, edit, adjust, or otherwise alter media for professional or educational use.

Confidentiality and Privacy:
Emphasizes respectful handling of all media, especially when documenting deeply personal or sensitive end-of-life moments.

Compensation or No Compensation:
States whether the client is receiving compensation or is offering consent without payment.

Time Period of Consent:
Specifies how long the client’s consent remains valid and whether it applies to future materials.

Revocation of Consent:
Explains how clients can withdraw consent and request removal or discontinuation of media.

Client Acknowledgment and Signature:
Includes a section for the client to confirm their understanding and agreement with all terms.

Key Features:

• Easy to Edit: Fully customizable to fit your death doula practice and client needs
• Print-Ready: Professionally designed for clean, easy printing
• Email-Friendly: Simple to download, complete, and share digitally
• Clear Consent Terms: Written with gentle, client-centered language to ensure clarity and comfort

How It Works:

• Purchase the Template: Access your digital files immediately
• Edit the Template: Personalize the form in Microsoft Word with your practice details and media guidelines
• Save and Use: Provide the form to clients to secure consent before using any media related to your support

Please Note:

• Personal Use Only: Redistribution or resale is prohibited
• Digital Product: No physical item will be shipped
• All Sales Are Final: Digital products are non-refundable

A compassionate media release form helps death doulas uphold privacy, maintain professionalism, and ensure all media is used only with informed and respectful consent. This template supports clear communication and strengthens trust within your death doula practice.