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Media Release And Consent Preferences Survey

Captures how comfortable people are with having their photo, video, or quote used in marketing, training, or press materials — and under what conditions. The AI follow-up interview digs into the reasoning behind any hesitation so legal and marketing teams know exactly what conditions to honor, not just a yes/no checkbox.

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Sample questions

A preview of what’s in the template. Every question is editable before you launch.

12 questions · ~7 min
Q01
Message

Thanks for taking a moment on this! We'd like your permission — and preferences — for using any photos, video, or quotes we may capture of you. This takes about 7 minutes and helps us respect your choices.

Q02
ConsentRequired

Please review the statement below before continuing.

Q03
Multiple ChoiceRequired

Which types of media are you comfortable being featured in?

  • Photos
  • Video
  • Audio/voice recordings
  • Written quotes or testimonials
  • None of these
Q04
MatrixRequired

How comfortable are you with your photo, video, or quote appearing in each of the following?

5 rows × 4 columns
  • Company website or blog
  • Social media posts
  • Printed materials (brochures, signage)
  • Internal training materials
  • Paid advertising campaigns
Columns: Not comfortable · Somewhat comfortable · Comfortable · Very comfortable
Q05
Opinion ScaleRequired

How comfortable are you with your full name being shown alongside your photo, video, or quote?

Scale: 1 – 5
Min:Not comfortable at allMax:Completely comfortable
Q06
Multiple ChoiceRequired

Would you like to review content before it's published?

  • Yes, review every use before it's published
  • Only for major campaigns or public-facing use
  • No, I don't need to review it first
Q07
Multiple ChoiceRequired

How long should your consent remain valid?

  • One-time use only
  • One year from today
  • Ongoing, until I withdraw consent
  • Indefinite, no expiration needed
Q08
Long Text

Are there any specific restrictions on how your photo, video, or quote can be used (for example: not in certain countries, blur my face, don't use my name)? Describe them here.

Q09
AI Interview

Explore the reasoning behind the respondent's comfort level and any restrictions they listed. If they marked low comfort or added restrictions, ask what specifically concerns them (context, audience, permanence) and what would need to change for them to feel comfortable. If they chose 'review every use,' clarify what a fast, low-friction review process would look like for them. If any answers about duration or review preference seem to conflict with their stated restrictions, gently surface the conflict and ask them to resolve it.

Q10
SignatureRequired

Please sign below to confirm the consent choices you've made in this survey.

Q11
Multiple Choice

What's your relationship to (Replace with organization name)?

  • Employee
  • Customer
  • Event attendee
  • Partner or vendor
  • Other
  • Prefer not to say
Q12
Message

Thank you! Your preferences will be logged and used to guide exactly how and where any media of you gets used. You can update or withdraw your consent at any time by contacting us.

What’s included

  • AI follow-ups

    Adaptive probes on open-ended answers that pull out detail a static form would miss.

  • Attention checks

    Built-in safeguards against rushed answers and low-quality respondents.

  • AI-drafted copy

    Wording, ordering, and branching written by the AI — tuned to your research goal.

  • Auto report

    Themes, quotes, and a plain-English summary write themselves once responses come in.

How it compares

We reviewed the closest templates from other survey tools. Here’s what they do well — and where this template goes further.

Why this template

  • Goes beyond a yes/no checkbox with a matrix question breaking down comfort level by media type and use case (marketing, training, press), plus an opinion scale on being named alongside the image.
  • Includes an adaptive AI follow-up interview that explores the reasoning behind any hesitation or restriction, so legal and marketing teams know exactly what conditions to honor rather than guessing from a flat form.
  • Captures durable consent terms explicitly — how long consent remains valid, whether the person wants pre-publication review rights, and open-ended restrictions on usage — then closes with a signature to confirm the specific choices made.
  • Auto-generates a report from structured answers and interview transcript, giving compliance teams a documented, defensible record instead of a static PDF.

Jotform

Consent Of Media Release Form Template

A ready-to-field static form template for collecting media release consent, built on Jotform's drag-and-drop form builder. It likely supports e-signature fields and basic conditional logic but captures a fixed set of questions rather than exploring individual reasoning. Good for quick legal sign-off collection at scale, not for nuanced preference-gathering.

What it does well

  • Fielding-ready template, easy to customize via Jotform's builder
  • Likely supports e-signature capture, a core need for consent forms
  • Broad integrations typical of Jotform's ecosystem

Where it falls short

  • No adaptive follow-up questioning to understand why someone hesitates or restricts usage
  • No per-response quality scoring or automated reporting
  • No transparent methodology for how questions are chosen or scored

SurveyMonkey

Social Media Consent Form Template

A static survey template focused on social media consent, using SurveyMonkey's standard question types. It's suitable for quick baseline consent capture but treats every respondent the same way regardless of their comfort level or concerns. No mechanism to dig deeper into conditional or partial consent.

What it does well

  • Familiar, fielding-ready survey format
  • Backed by SurveyMonkey's established analytics and reporting dashboard
  • Easy distribution across common channels

Where it falls short

  • No adaptive AI interviewing to surface the 'why' behind restrictions
  • No voice AI interview option for respondents who prefer speaking over typing
  • No transparent, publishable prompt/methodology behind question logic

SurveySparrow

Free Social Media Photo Release Form Template

A conversational-style, static template aimed at collecting photo release consent for social/marketing use. SurveySparrow's chat-like UI improves completion experience over traditional forms, but the question set is fixed and doesn't adapt based on answers. Best for simple opt-in/opt-out capture rather than nuanced condition-setting.

What it does well

  • Conversational UI likely improves completion rates versus flat forms
  • Fielding-ready, free template lowers barrier to start
  • Marketing-oriented template positioning fits campaign use cases

Where it falls short

  • No adaptive follow-up probing into reasoning behind partial consent or restrictions
  • No automated per-response quality scoring
  • No guided task or screen-share capability for more complex consent walkthroughs

Typeform

Media Release Form Template

A polished, conversational static form for media release consent, leveraging Typeform's signature one-question-at-a-time flow. It's fielding-ready and visually strong, but like other static tools it can't dynamically explore individual concerns or generate a synthesized report on reasoning.

What it does well

  • Strong conversational UX known for higher completion rates
  • Fielding-ready template with Typeform's design polish
  • Logic-jump capability for basic branching

Where it falls short

  • No adaptive AI follow-up interview to uncover reasoning behind hesitation
  • No automated quality scoring or auto-generated compliance report
  • No transparent prompt methodology published for how branching decisions are made

Ready to launch?

Open this template in the editor. Every part is yours to change before the first respondent sees it.

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