Record Consent Agreement

Disciplinary Consent Agreement Recording Portal

Use this tool to record your official audio or video statement of assent regarding your formal Consent Agreement with the West Virginia Board of Registered Nurses.

📋 Recording Instructions & Requirements

1. Review Your Script: Read the required verbal statement in the box below before starting your recording.
2. Choose Media Format: You may record either a video or an audio statement using the tools provided below.
3. Save & Submit: Once completed, preview your recording, download the file to your computer, and submit it as directed by the Disciplinary Review Committee.

📜 Official Verbal Consent Script

"My name is [State Your Full Legal Name].
My nursing license number is [State Your License Number].
Today's date is [State Today’s Date]."

"I am recording this statement to provide my formal, legal assent to the disciplinary Consent Agreement regarding case number [State Your Case Number].
I confirm that I have received, read, and fully understand the entire Consent Agreement."

"I understand that by accepting this agreement, I am waiving my right to a formal administrative hearing, my right to present evidence or witnesses in my defense, and my right to appeal this matter."

"I am entering into this Consent Agreement freely and voluntarily. I have not been coerced, threatened, or promised anything outside of what is written in the agreement. I understand that I had the right to consult with an attorney before making this decision."

"I accept and agree to be bound by all terms, conditions, and stipulations outlined in this Consent Agreement."

Recording Tools

🎥 Video Consent Recorder

Records video and audio (MP4).

Ready. Click "Start Camera" to begin.

🎙️ Audio Consent Recorder

Records microphone audio only (MP3).

Ready. Click "Record Audio" to begin.

Submitting Your Recording

After downloading your recording file, transmit it to the Board along with your signed Consent Agreement paperwork:

  • Email Submission: Send the file to your assigned Board Compliance Officer or rnboard@wv.gov with your full name and case number in the subject line.
  • Questions or Technical Issues? Contact the Discipline Department at (304) 744-0900.