Patient Consent Form

Name *

First Name

Last Name

Emergency Contact Name

First Name

Last Name

GP's Name

First Name

Last Name

Terms of use *

Your data will be stored in secure servers in accordance with General Data Protection Regulation 2018. Any changes in the security settings of your data will be notified to you promptly. If at any time you wish to stop receiving communications from us, you can inform us to change your preferences. I have the right to erasure (right to be forgotten) of my personal data. I understand that I can request my personal data at any time. I understand the Acmed Services Ltd. may have to share my details, with my GP, other relevant healthcare professionals, relevant pathology services and my insurance providers on a need to know basis as and when appropriate. I understand that administrative officers and clinicians at Acmed Services Ltd. will have access to relevant data for specific purposes. E g: creating reports, invoicing, appointment management, liaising with healthcare professionals, and relevant pathology services. I understand that I can withdraw consent for treatment at any time.

I accept