GDPR consent | website

SPORTS THERAPY SERVICES DATA CONSENT FORM

During the course of your treatment at Sports Therapy Services (STS), you will be requested to supply your contact details and confidential personal information such as your date of birth, medical history and details of previous and current treatment. The information is used so that we can provide the best possible treatment options for you, and can contact you for appointment purposes. We may also use the contact details for occasional marketing or information relaying.

The GDPR (General Data Protection Regulation) now requires that we obtain explicit consent for data collection and processing. Please can you read the statements below, tick where appropriate and sign to show your consent.

If you have any queries regarding how we store your data or any other issues regarding data protection at STS, then please ask to speak to the registered data controller Lesley Burtenshaw (aka Oleksyn).

You agree to update STS if any of the details change, and understand that you can change consent to the above at any time.

First Name

Last Name

I agree to STS collecting and processing my personal contact details for appointment purposes. Telephone numbers and email address will be stored on the mobile phone, PC and in the cloud-based patient information system of the data controller, and used for the purposes of appointment scheduling and reminders, and NHS COVID-19 Track and Trace.

I agree to STS collecting and processing my personal contact data for occasional marketing and client information purposes.

I agree to STS collecting and processing my confidential and special data to enable the most appropriate treatment plan can be arranged. These will be stored as paper files in a locked cabinet at the clinic address or on a secure electronic cloud-based patient system.

I have read the STS Data Privacy Notice and have asked for and received appropriate clarification where I required it. See the link to Privacy Notice at the bottom of the page.

Date

Print Full Name

I confirm that the information given in this form is true. By submitting this form, I agree to data being collected in this way.

Thanks for submitting!