Consent to share information about you
If a third party (eg. your insurance company, employer or rehabilitation service) are funding therapy, they may ask for an initial assessment report from me.
To share this with them, I require your informed consent. Please read this form and complete it only once you are satisfied with the contents of the report and if you wish this to be sent to your chosen third party.
Please contact me with any questions prior to submitting. I comply with the General Data Protection Regulation and I want you to be happy with, and in control of, who sees your information, thank you.
Sharing this initial report does NOT give further access to your therapy notes, which remain confidential as per our therapy contract.