Consent GDPR Form - drmusasami.co.uk

Please review and confirm the consent and privacy statements below before your assessment.

Please confirm the details below.

Patient ID

Full name

Email address

Phone number

I consent to Dr Musa Sami and the clinical team reviewing my information and providing assessment or care as appropriate.

I understand that my personal and clinical information will be securely stored as part of my clinical record.

Please confirm how we may contact you about your care.

I consent to being contacted by email.

I consent to being contacted by phone.

I consent to being contacted by SMS or WhatsApp where appropriate.

Do you consent to relevant clinical information being shared with your GP or other healthcare professionals where clinically appropriate?

Notes about information sharing

I confirm that I have read and understood the Privacy Policy.

I confirm that the information provided is accurate and that I am submitting this consent form myself.