Request
Inputs marked * are required
Requestor's Information
Are you an MD Anderson employee?
If Requestor is not an MD Anderson Employee
Project Details
Specific description of scene(s) you intend to film (interview, b-roll, clinic appointment, etc.)
Are you asking to film any MD Anderson patients?
*If approved, HIPPA Authorizations and media releases must be obtained prior to filming.
Does the video production company have liability insurance coverage in the amount of $1 million for property damage and $2 million for injury or death?
Number of people in video team for on-campus filming (include any producers, videographers, photographers, etc. who will be at MD Anderson)?
Project Purpose
Describe the final video you intend to produce using the scenes filmed at MD Anderson. Include any other interviews and scenes to be filmed outside of MD Anderson.
How will the video be distributed?
How will MD Anderson be described/portrayed in the video?
How will the video benefit MD Anderson's mission?
If this request is related to an event or conference, please provide details. (Optional)
Is there anything else you want to share about your project to help us evaluate your request? (Optional)
Click on the “Submit” button below to email your completed request to Public Relations for review. (This will open a new email window with the form attached; send the email to submit.)
Submitting this form is not a guarantee of approval for your request to film on campus.