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Patient Information Sheet

If you wish to utilise our new video consultation service please fill in the following form and submit it to us so that we can update our records.

Many thanks

Steve and Kirsten




Online Consent

I CONSENT TO VIDEO/ONLINE CONSULTATION

I AGREE TO CHARGES FOR ONLINE CONSULTATION AND WILL MAKE BACS PAYMENT FOR THE SERVICE PROVIDED (UNLESS PRIVATE INSURANCE/MEDICOLEGAL)

Please read and sign the declaration below (you can withdraw your CONSENT at any point, Please inform us if you do)

I understand that failure to attend a scheduled appointment will result in a charge equal to the treatment fee, if I fail to give 24 hours notice of cancellation. I understand this charge will be my responsibility as my insurance company will not cover any failure to attend.

I hereby give CONSENT for you to securely hold my personal details under new GDPR criteria and duration

I hereby give CONSENT (if applicable) for you to share details with other medical professions/insurance companies if my treatment requires it

I hereby give CONSENT for you to use my mobile number or email for appointment reminders (if needed)

  • Opening Times

    Monday to Thursday 

    8am to 6.30pm

    Friday 

    8am to 5pm

    Appointments 

    30 mins

    Charge £40

    The cost of the video/virtual consultation will be as follows:

    IA: 30 mins @ £30
    FU: 30 mins @ £30

    Contact

    01264 334158
    07813095613