Wholistic, Excellence In Women’s Health
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COLLECTION OF PERSONAL INFORMATION As a patient of our medical practice, we require you to provide us with your personal details and a full medical history, so that we may properly assess, diagnose, treat and be proactive in your health care needs. We aim to protect the privacy of your health information.
We require your consent to collect your personal information, and for its use in the following ways:
By providing my name below, I acknowledge that I consent to the handling of my information by this practice for the purposes set out above.
PAYMENT PROCEDURES & CONSENT You are required to pay your account at the time of consultation. Please advise the receptionist if you are unable to do this prior to your appointment. This practice uses a Debt Recovery service for overdue accounts. Any charges incurred for this service will be passed on to the patient. We understand you may need to cancel your scheduled appointment, please notify us as soon as possible, however if an appointment is missed or cancelled without 1 business days’ notice a fee may be incurred.
By providing my name below, I acknowledge that I understand my obligation with regard to payment of my account.
IMAGES & VIDEO Education and teaching is an important part of the practice and the use of images and video is sometimes used for research and teaching purposes of other healthcare professionals. The images and data are kept strictly confidential and your name, DOB, and all other identifying details are removed prior to their use. Please sign and date below if you consent to the use of your images and video.
By providing my name below, I acknowledge that I consent to the use of my images and video by this practice for the purposes set out above.
Nureva Women’s Specialist Health is committed to providing our patients with the best possible care. In order to do this effectively, it may become necessary to obtain your previous test results, doctor’s reports and operation records from other parties whilst you treated at our practice. As with all your health information that we hold, we aim to protect your privacy by complying with the current legislation guidelines
The patient below now attends this practice, and has provided their consent below. Could you kindly forward the following information at your earliest convenience.
By providing my name below, I give permission for Nureva Women’s Specialist Health to collect my medical information for the purposes set out above.
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