Consent for Media Coverage

  • I do hereby give my permission for Newman Regional Health public relations officials, other designated hospital officials, or employees of local/regional media, to interview, photograph, audio record, video record, use my photograph or image, and use any verbal or electronic communication for the purposes indicated below.
  • Drop files here or
    Max. file size: 50 MB.
    • Full Name of Patient/Subject
    • By clicking below I submit my authorization and consent

    Connect With Us

    Newman Regional Health
    1201 W 12th Avenue
    Emporia, KS 66801
    620-343-6800
    Newman Medical Plaza
    1301 W 12th Avenue
    Emporia, KS 66801