Initial Consultation Form

Due to the coronavirus and the requirement to reduce contact time as much as possible, I am now completing my initial consultation documents online. These forms need to be completed and submitted to me at least 24hours before your appointment or your appointment will need to be cancelled. The form below contains a privacy and consent form and a consultation.

The Privacy and consent form is part of General Data Protection Regulation and advises you why I will be asking the questions for the consultation, your rights around the information, my rights and what I will do with your information.

The consultation is so I know of any particular issues to be aware of for your therapy session.

The information you provide will be submitted and sent to me by email. I will then add it to my secure client database and the information will be deleted from my email server. If you have any concerns regarding the information being provided, please send an email to contact@louise-morgan.co.uk with your concerns and we can complete it as a telephone consultation. If I have any questions regarding your consultation form I will ask you on the day. Once submitted you will receive an email saying Booking with Louise Morgan confirming your submission.

PRIVACY AND CONSENT NOTICE
YOUR PERSONAL INFORMATION - GENERAL DATA PROTECTION REGULATION (GDPR)

Therapist’s Contact Details: Louise Morgan, Therapy Centre, 12 Kinsale Road, Bristol BS14 9HB 07779 234144, contact@louise-morgan.co.uk
Data Controller Contact Details: Louise Morgan

The Purpose of processing Client Data
I hold and use client data in order to provide you with the best possible treatment options, support and advice.

Lawful Basis for holding and using Client Information
The lawful basis under which I hold and use information is in order to provide you with the best possible treatment options and advice, and my requirement to hold your information in accordance with legal reasons relating to ‘claims occurring’ insurance: (records to be kept for 7 years after last treatment).

As I hold special category data (i.e. health related information), the Additional Condition under which I hold and use this information is for me to fulfil my role as a health care practitioner bound under the AoR, the IFPA and the FHT Confidentiality, as defined in their Code of Practice and Ethics.

What information I hold and what I do with it
In order to give professional treatments, I will need to ask for and keep information about your health. I will only use this for informing treatments and any advice I give as a result of your treatment. The information to be held is:
• Your contact details
• Medical history and other health-related information
• Treatment details and related notes I will NOT share your information with anyone else (other than as required for legal process) without explaining why it is necessary and getting your explicit consent. I will keep your information in line with the lawful basis listed above.

Protecting Your Personal Data
I am committed to ensuring that your personal data is secure. In order to prevent unauthorised access or disclosure, I have put in place appropriate technical, physical and managerial procedures to safeguard and secure the information we collect from you.

Your Rights
GDPR gives you the following rights:
• The right to be informed: To know how your information will be held and used (this notice).
• The right of access: To see your therapist’s records of your personal information, so you know what is held about you and can verify it.
• The right to rectification: To tell your therapist to make changes to your personal information if it is incorrect or incomplete.
• The right to erasure (also called “the right to be forgotten”): For you to request your therapist to erase any information they hold about you
• The right to restrict processing of personal data: The right to request limits on how your therapist uses your personal information
• The right to data portability: Under certain circumstances you can request a copy of personal information held electronically so you can reuse it in other systems.
• The right to object: To be able to tell your therapist you don’t want them to use certain parts of your information, or only to use it for certain purposes.
• The right to lodge a complaint with the Information Commissioner’s Office: To be able to complain to the ICO if you feel your details are not correct, if they are not being used in a way that you have given permission for, or if they are being stored when they don’t have to be. If you wish to exercise any of these rights, please email contact@louise-morgan.co.uk Full details of your rights can be found at https://ico.org.uk/for-organisations/guide-to-the-general-data-protection-regulation-gdpr/individual-rights/. If you are dissatisfied with the response you can complain to the Information Commissioner\'s Office; their contact details are at: www.ico.org.uk

THERAPIST’S RIGHTS
Please note:
• if you don’t agree to your therapist keeping records of information about you and your treatments, or if you don’t allow them to use the information in the way they need to for treatments, the therapist may not be able to treat you
• Your therapist has to keep your records of treatment for a certain period as described above, which may mean that even if you ask them to erase any details about you, they might have to keep these details until after that period has passed
• Your therapist can move their records between their computers and IT systems, as long as your details are protected from being seen by others without your permission.
DECLARATION I have seen this document and understand that you will hold and use my personal information, using it in order to provide me with the best possible treatment options and advice in line with the statements above.
CONSULTATION FORM: