PRE-ASSESSMENT FORM
PLEASE COMPLETE THIS SHORT FORM
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In order for any treatment to take place the Forest Physio will need to collect and store certain information.  This form  ensures that you know what is done with your information and that you consent. All information collected will be kept strictly confidential and will not be shared with any third parties.  
First Name *
Last Name *
Collection and storage of clinical information
As a part of your treatment, I am required to create and store medical  records  concerning your treatment. This may include details of medication, medical history and details of your treatment.  Slow motion videos are also captured and stored securely on a secure cloud (HUDL Technique).  Your data will be treated confidentially and will not be shared with any third party’s.  The collection and storage of this data is in  accordance  with  the  General  Data Protection  Regulation  (GDPR).  These  records  will be  retained  for  eight  years (Or  until  I  reach  25  in  the case  of  someone  aged  16-18) and stored on a secure, encrypted cloud (Google Drive) from  when  treatment  is  ceased  in  order  to  comply  with  BMA  standards  and  HCPC recommendations.  
Do you consent to the storing of your clinical information? *
Communication
Occasionally the Forest Physio may want to contact you to make appointments, to ask for updates on your treatment, for general administation or to tell you about offers (I will not spam you).
The Forest Physio may need to contact you via email and telephone/sms, are you happy with this.
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