Please complete the consultation intake form below before your first appointment. It provides me with essential and contextual information about yourself, your health history and your aim from the session. It will help me provide the care and treatment best suited to you.
If you’re unable to complete the form please let me know.
The form has 4 sections – allow 10 minutes to complete it:
GDPR Consent & Personal Information
About Your Visit & Complaint(s)
Lifestyle & Client Declaration
If you have any reports or documents you’d like to show, please bring them with you to your appointment, remembering to mention this in the form.
If you have any questions, I’m always happy to help.
The security of the data you share with me on this form and in our session(s) is important to me. Your data will never be shared with anyone else unless agreed to, or legally required, and will only be used for its intended purpose. All sessions are conducted in strict and explicit confidence and all digital and physical data are stored in a secure, restricted manner no longer than required.
Under GDPR (General Data Protection Regulation) you have the following rights:
The right to be informed about how your personal information is collected and used.
The right of access to the personal data held about you.
The right to have any incorrect or incomplete information corrected.
The right to be forgotten i.e. the right to have any personal information deleted.
The right to restrict how your personal information is used.
If you find that the form resets after your careful filling it in, please spell your medication differently, for example: p e n i c i l l i n , or pen_ic_illin. Alternatively, omit it/them from the form and reply to my email with the medications instead. Dosage NOT required, just the name of your medication suffices.
Some types of medication appear to reset the intake form, for example “penicillin”. This is due to specific medications being flagged by (seemingly hyper-vigilant) secure anti-spam tech by my host – it is good but sometimes a bit too good!
My apologies in advance for any inconvenience this may cause and thank you for your understanding.
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