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VR Experience Consent Form

Virtual Reality Experience Consent Form

Please read all of this page and then sign the consent form in order to do the VR experience at GCPA’s 2024 Conference. You must also see a GCPA member to get a time slot for the experience. Signing this consent form is not a guarantee of a slot at the VR experience.

Trigger Warning Statement

We want to ensure that we can facilitate an engaging and safe virtual reality (VR) experience. However, participants should be aware that VR content can sometimes trigger strong emotional or physical responses. Please review the following information carefully.

This content contains 360-degree interactive videos covering various healthcare topics that some viewers may find distressing. Specific segments includes’ themes of wound care, realistic portrayals of dementia, sensitive discussions and depictions related to end-of-life care and conversations, scenarios involving mobility issues and falls, and depictions of angina attacks. Viewer discretion is advised, particularly for those who may be sensitive to medical procedures and discussions of illness and mortality. Individuals with PTSD, anxiety disorders, or similar conditions may find certain content distressing.

Please be aware that for some individuals, VR can induce motion sickness. If you feel nauseous, dizzy or uncomfortable at any point during the experience, please remove the headset. If you have any concerns regarding specific content or potential triggers, please speak to a facilitator before participating and inform a facilitator immediately. Your safety and comfort are our top priorities.

Risk of Seizures

Some individuals (approx. 1 in 4000) may experience severe dizziness, seizures, twitching, or blackouts triggered by light patterns. These can occur during TV, video games, or virtual reality, even without prior history. If you experience these symptoms, stop using the headset immediately. If you have a history of seizures or epileptic symptoms, you must consult a doctor before taking part in the simulation.

Data Collection

By proceeding with this simulation, you agree to the collection and use of the data collected in this form for analytical and research purposes. Your session may also be recorded by your instructor with video/photography equipment. If you would not like to be photographed during the experience, please let a facilitator know beforehand. All data collected will be handled with confidentiality to protect your privacy.

Consent for VR Experience

To ensure the safety of all participants, please complete this form.


• Epilepsy or seizures • Heart conditions (e.g., arrhythmias, angina) • Severe motion sickness • Anxiety disorders or PTSD • Recent head injuries or concussions • Vision or balance disorders • Pregnancy