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