Intake Form | Bea Sports Injury Clinics

Under the Data Protection (1998) Act, and to conform with GDPR, we are required to advise our patients on our Data Protection Policy and how we handle your data. All information provided will be treated as confidential, and will not be given to any other person/organisation without the written consent of the patient concerned. As part of the Patient Record this clinic is required to retain information for the purpose of consultation for treatment and recording subsequent treatments. Use by third party medical practitioners will only be allowed with the specific permission of the patient in writing. Upon completion of the Patient Details Form, Data Protection and Consent form, all paper files and information may be electronically scanned and stored on a computer file, or alternatively retained as paper records, for as long as the patient remains a patient of the clinic, and thereafter for a period of 7 years . Information held both manually and electronically in files will be accessible only by staff of the clinic directly involved in the data entry and processing of patient records. By ticking this box, you acknowledge that you have read the Data Protection Policy and hereby give consent to the practitioner to maintain records for the purposes outlined within this Policy.I agree to your data policy

Patient Details

Address

PATIENT MEDICAL HISTORY

Section

Section

Your Agreement

Data Protection

Thank you

Patient Details

Address

PATIENT MEDICAL HISTORY

Section

Section

Your Agreement

Data Protection

Thank you

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