Free consent withdrawal and content removal request form

Anyone who appears in content should have a simple way to ask for it to come down. This form lets a performer list the content, say why, and say what they want removed. The second half tells the producer or website exactly how to handle the request and how fast.

Card network rules for adult merchants expect every site to accept removal requests from people shown in content, review them quickly, keep consent-related content down during review, and offer an appeal.

How to fill this out

Say who it is going to

Fill in the producer, co-creator or website, and their removal contact.

Describe the content

List each piece of content with its title and URL or platform.

Tick your reasons and requests

Check every reason that applies and what you want done.

Sign and send

Sign the statement and send the form to the removal contact. Keep a copy.

Recipients: follow the steps

Producers handle the request with the timeframes in the recipient table, and never charge a fee.

Full template (free to read)

Consent Withdrawal and Content Removal Request Form

Free template. Not legal advice. This document is a starting point only. Laws differ by state and country, and platform and payment processor rules change often. Have a licensed attorney in your jurisdiction review it before you use it. Using this template does not create an attorney-client relationship with anyone. Released under CC0 1.0 (public domain): copy, change and share it freely, no credit needed.

How to use this form: A performer or creator who appears in content uses this form to ask a producer, co-creator or website to take it down. Producers can also publish it as their removal request form. Replace every item in [BRACKETS]. You should never be charged a fee to make a request.

Send this request to


Producer, co-creator or website	[PRODUCER LEGAL NAME OR WEBSITE NAME]
Removal contact email or form	[REMOVAL CONTACT EMAIL]

Part 1: About you


Your name (stage name is fine)	[YOUR NAME OR STAGE NAME]
Contact email	[YOUR EMAIL]
Your relationship to the content	[I APPEAR IN IT / I AM A CO-CREATOR / I AM AUTHORIZED TO ACT FOR SOMEONE WHO APPEARS IN IT]

Part 2: The content

Title or description	URL or platform	Date of production (if known)
[CONTENT TITLE]	[CONTENT URL]	[DATE OF PRODUCTION]
[CONTENT TITLE]	[CONTENT URL]	[DATE OF PRODUCTION]

Part 3: Reason for the request

Check every box that applies.

[ ] I did not consent to being recorded.
[ ] I did not consent to this content being published or distributed.
[ ] I am withdrawing my consent to further distribution.
[ ] The content shows more than I agreed to.
[ ] I was under 18 when it was recorded.
[ ] I was impaired, pressured or coerced when it was recorded.
[ ] The content is posted on a platform or site I did not agree to.
[ ] My legal name or private information is shown.
[ ] Other: [DESCRIBE]

Details (optional): [DETAILS]

Part 4: What I am asking for

[ ] Remove the content from every website and platform you control.
[ ] Remove trailers, stills, thumbnails and promotional uses.
[ ] Ask third-party platforms you distributed to, to remove it.
[ ] Help me request removal of copies posted by others.
[ ] Confirm in writing when removal is complete.

Part 5: Statement

I confirm that the information in this request is true to the best of my knowledge, and that I am the person shown in the content or am authorized to act for them.

Signature: ______________________ Date: ______________

For the recipient: how to handle this request

Step	Timeframe	Done
Log the request (date received, content, requester, reason)	Same day	[ ]
Send acknowledgement to the requester	Within [1] business day	[ ]
If the request involves a possible minor: disable immediately, preserve evidence, report to the NCMEC CyberTipline and law enforcement, never restore	Immediately	[ ]
If the requester says they did not consent, or content shows more than agreed: disable from public view while reviewing	Immediately	[ ]
Review the records: signed release, ID record, consent clip, agreed activities	Within [5] business days	[ ]
Send a written decision to the requester	Within [5] business days	[ ]
If removed: remove from every site, trailer, promo channel and third-party platform, and do not re-upload	Within [5] business days	[ ]
If disputed: allow an appeal, and refer an unresolved consent dispute to an independent neutral third party at the producer's cost	[NUMBER] business days	[ ]
Keep a record of the request and the outcome	At least [7] years	[ ]

No fee, purchase or transfer of rights is ever required to request removal or to appeal.

Frequently asked questions

Can I withdraw consent after content is posted?

You can always ask. What happens next depends on your agreement and the law where you are, but content must come down if you did not consent, if it shows more than you agreed to, or if you were under 18.

Should I have to pay to get content removed?

No. No fee, purchase or transfer of rights should ever be required to request removal or to appeal.

How fast should a website respond?

A good practice is acknowledgement within one business day and a decision within five business days, with consent-related content disabled while the request is reviewed.

What if the content was copied to other sites?

Use Part 4 to ask the producer to help with takedown of copies. You can also send copyright or non-consensual content reports directly to those sites.