Activate
Physio for women

PHYSIO FOR WOMEN

Privacy and Service Agreement

 

Privacy and Service Agreement

We have written this brief document in plain english so it is easy to read and understand. It is important information you need to know about your privacy and consent.

What information do we collect?

When you use our services we collect information to enable us to provide you with care. We work hard to protect your information and understand this responsibility. We collect personal information such as contact details and medical history. During a treatment session we create clinical notes that contain personal information you provide. This information is stored in a private medical record on our clinical system.

Why do we collect this information?

We collect this information to enable us to provide you with our services and to communicate with you. Only those directly involved in providing services to you can access your information. To provide you with care it may be necessary for us to communicate with other health professionals such as your doctor or a specialist. From time to time we may communicate with you about events or send information we feel is relevant to you. We are committed to your privacy and do not share your details with any marketing or advertising agent.

How can you be in control of your information?

At any time you may request a copy of your information from your treating physiotherapist or withdraw your consent for us to store and share information by writing to welcome@activate.care

Our service agreement with you.

When you use our services we agree to provide professional treatment in a safe environment. We will communicate with you our fees for service prior to a treatment session so you know what to expect. In return for our services you agree to attend your appointment on time and pay in full for our services at the conclusion of the treatment session.

Your consent and agreement with us.

To enable us to provide services to you please complete the form below and sign and date at the end of this document to indicate your consent to information collection and acceptance of the service agreement.

Correspondence will automatically be sent to your referring doctor and usual GP Please inform your physiotherapist if you do not want correspondence sent.

ELECTRONIC CONSENT:

Name *
Name
Date *
Date
Please type your name here as an electronic signature.

YOUR CONSENT

Either print this page and sign and date, or fill out the form here.

FIRST & LAST NAME:

TODAY’S DATE:

SIGNATURE: