CONSENT FORM | Tanya Cohen

GDPR Consent Form – Managing your personal data

As part of your healthcare:

Simply Nutritious may share your sensitive information with third parties to support your ongoing healthcare. If we do not receive this consent from you, we will not be able to coordinate your healthcare with that provided by other providers which means the healthcare provided by us may be less effective.

Simply Nutritious will never reach out to a third party disclosing sensitive information before asking for your consent first.

Please tick the appropriate boxes to confirm your consent:

Simply Nutritious may also share your contact information with biochemical testing companies to order tests as part of your healthcare, some of which maybe from outside of the United Kingdom. If we do not receive this consent from you, we will review alternative tests from providers based in the UK.

Please tick the box to confirm your consent:

You can withdraw your consent to the above at any time by emailing hello@simplynutritious.co.uk

Storage and disposal of your data

Any hard copies of your personal data are stored in a locked filing cabinet.

Any electronic personal documents and information is stored in the OneDrive part of Office 365, which is GDPR compliant.

Your personal data is retained for 8 years after the date of your last appointment.

I consent to my personal data being shared with my GP.

I consent to my contact information being shared with biochemical testing companies outside of the United Kingdom.

I consent to my personal data being shared with other healthcare providers, whose details I have provided (eg Laboratories in the UK).

Print Full Name of Client:

Print Full name of Guardian (if Client is under 18):

Signature of Client OR signature of Guardian (if Client under 18):

Date

Thanks for submitting!