Patient Registration Form

“Dr Carmen respects your personal information and right to privacy. The personal information collected in this Patient Registration Form (including your name, address, email, phone number and medical history) is used for the purpose of providing treatment to you and to contact you when necessary. Your personal information will be collected, handled and stored securely by Dr Carmen in line with privacy law. Disclosure of your personal information will not be made to any person not involved in either your treatment or the administration of this practice, without your prior consent. A copy of our Privacy Policy is available at Reception. By completing and returning the Patient Registration Form, you acknowledge and agree to your personal information being collected, used and stored in the manner stated above”