VAFORMS.NET – VA Form 10-3203a – Informed Consent and Authorization for Third Parties to Produce or Record Statements, Photographs, Digital Images, or Video or Audio Recordings – The Department of Veterans Affairs offers many benefits to those who have served in the armed forces. One of these benefits is the option to receive treatment for mental health conditions. In order to receive this treatment, veterans must sign a form that gives the VA permission to share their information with third parties.
Download VA Form 10-3203a – Informed Consent and Authorization for Third Parties to Produce or Record Statements, Photographs, Digital Images, or Video or Audio Recordings
| Form Number | VA Form 10-3203a |
| Form Title | Informed Consent and Authorization for Third Parties to Produce or Record Statements, Photographs, Digital Images, or Video or Audio Recordings |
| Edition Date | August 2022 |
| File Size | 1 MB |
What is a VA Form 10-3203a?
A VA Form 10-3203a is a document that provides consent and authorization for third parties to produce or record statements, photographs, digital images, or video or audio recordings. This form must be completed by the Veteran and signed by a witness in order for the release of information to occur. The purpose of this form is to protect the Veteran’s privacy and confidentiality.
Where Can I Find a VA Form 10-3203a?
If you are a Veteran seeking care through the Veterans Health Administration (VHA), you may be asked to sign a VA Form 10-3203a. This form gives VHA permission to allow third parties to produce or record statements, photographs, digital images, or video or audio recordings of you.
You can find the VA Form 10-3203a on the VHA website. The form is available in English and Spanish. If you have any questions about the form, please contact your local VHA facility.
VA Form 10-3203a – Informed Consent and Authorization for Third Parties to Produce or Record Statements, Photographs, Digital Images, or Video or Audio Recordings
If you are a Veteran receiving care through the Veterans Health Administration (VHA), you may be asked to sign a VA Form 10-3203a. This form is used to give VHA permission to allow third parties, such as media outlets, to produce or record statements, photographs, digital images, or video or audio recordings of you.
By signing this form, you are giving your consent and authorizing VHA to release these materials to the third party. You also understand that the materials may be used by the third party for any purpose, including commercial purposes.
If you have any questions about this form or what it means to sign it, please speak with a VHA staff member.
VA Form 10-3203a Example
