Privacy Form That is Signed by Each Patient at First Consultation

Any personal information communicated during consultations is for the sole purpose of providing homœopathic treatment. Any information that I disclose as a client will remain strictly confidential unless I specifically request otherwise, or it is required by New South Wales or Australian Federal law. 

 

Any information disclosed will be protected using appropriate physical, electronic & managerial procedures to prevent unauthorised access and to ensure the information is used correctly.

 

  • I give permission for my practitioner to confer with colleagues regarding my case in order to offer me a better health care service.

Yes  /  No

 

  • I give permission for my case details to be used anonymously for educational & research purposes, such as a case study as example in a lecture.

Yes  /  No

 

  • I give permission for the practitioner to pass information to other health professionals if necessary (eg medical practitioner, chiropractor).

                                                                                                                        Yes  /  No

 

  • I give permission for the practitioner to record the consultation for educational purposes

Yes  /  No

 

  • I give permission for monthly newsletters to be sent to  my email address

Yes  / No

Use medicines only as directed. If symptoms persist see your health practitioner.

This advice does not replace professional care. These suggestions are for treatment of minor ailments only

and are not suitable for treatment of chronic, serious or ongoing illness. 

ann@restoringhealth.com.au     0413 010 050

1/30 Elizabeth St, Artarmon NSW 2064