Parental Consent on behalf of a Child GDPR Form

PARENTAL CONSENT ON BEHALF OF A CHILD FOR GDPR FORM

Explicit Consent

I explicitly consent to you creating and storing medical records concerning the treatment of: [patient name]. I understand that this may include details concerning medication, treatment and other issues affecting health conditions, in accordance with the General Data Protection Regulation (GDPR).

I understand that these records will be retained until the child reaches 25, or when the 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, a copy of which I have seen.

I have read and understood the above information and have the authority to give explicit consent on behalf of the patient.

link to privacy policy https://ninabain-osteopath.com/pages/privacy-policy

Have you read and agreed to our privacy policy ? *

First Name

Last Name

Date of Birth

Patient/ Guardian Signature

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DATE *

NAME OF CHILD

I am acting in the capacity of parent or legal guardian (please state)

SIGNATURE *

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DATE

Preferred Communication Route

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

PHONE EMAIL SMS OTHER (please state)

Other

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 and your child.

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

Methods for promotional information

Phone Email SMS Other ( please state)

Other

Signed please sign in the box *

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DATE *

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