GDPR Patient Consent Form

I explicitly consent to you creating and storing medical records concerning my treatment, which may include details concerning my medication, treatment and other issues affecting my health conditions, in accordance with the General Data Protection Regulation (GDPR). I understand that these records will be retained for eight years, or until I reach 25 in the case of someone aged 16 - 18, when treatment is ceased in order to comply with the Institute of Osteopathy legal guidelines. I understand that these records will be processed in accordance with your 2018 Privacy Notice,

https://ninabain-osteopath.com/pages/privacy-policy a copy of which I have seen.

I have read and understood the above information and give my explicit consent

*

PATIENT DETAILS

First Name

Last Name

Preferred Name

Date of Birth

Signed *

Email address *

Please sign or type in the Box *

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COMMUNICATION PREFERENCES

For future appointments and administration, our preferred communication route/s is:

Phone EmailSMSOther ( please state)

Promotional Information

For the purposes of promoting healthcare including offers and advice the Practice would also like to stay in touch with you, with information that may be of interest to you.

For providing promotional information you can stay in touch with me using the following methods:

Phone EmailSMSOther ( please state)

Other

Signature *

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