Esther Adebisi, Therapist At HMB

Please confirm the declaration of consent below. Thank you.

I understand that the service provided by HelpMindBody is not intended for crisis situations and urgent needs. In a crisis situation, I agree to call 999 or the local emergency services or visit the nearest emergency room. Information shared with my therapist is confidential except in the following circumstances: if I pose a danger to myself or others, a mandatory report of abuse by children or elders, or if I sign a release of information.

1. DECLARATION
   1. I have seen this document and understand that you will hold and use my personal information, using it in order to provide me with the best possible treatment options and advice in line with the statements above.

__________________________________________________ Full Name __________________________________________________ Signature Date: ____________

GDPR CONSENT

AGREEMENT

GDPR (implemented by DPA2018 in the UK) brought in new legal protection for personal information in May 2018. This tells you what personal information Help Mind Body holds and why, and what your rights are. Once you have read it please complete and sign the declaration/statement of consent at the bottom.

Therapist’s and Data Controller’s Name/Identity: Daniel Tete Gunn

Therapist’s Contact Details:

Telephone No: (+44) 79 3979 4979

Email address:  [email protected]

Web Address:    http://helpmindbody.com

1. The Purpose of processing Client Data
   1. In order to give professional holistic treatments, Help Mind Body will need to gather and retain potentially sensitive information about your health. Help Mind Body will only use this information for informing reflexology treatments and associated recommendations concerning aspects of health and well-being that Help Mind Body will offer to you.
       
2. Lawful Basis for holding and using Client Information.
   1. As a full member of the Federation of Holistic Therapists, Help Mind Body abides by the FHT Code of Practice and Ethics. The lawful basis under which Help Mind Body holds and uses your information is our legitimate interests i.e. our requirement to retain the information in order to provide you with the best possible treatment options and advice. As Help Mind Body holds special category data (i.e. health related information), the Additional Condition under which Help Mind Body holds and uses this information is: for us to fulfil our role as a health care practitioner bound under the FHT Confidentiality as defined in the FHT Code of Practice and Ethics.
       
3. What information Help Mind Body holds and what does Help Mind Body with it
   1. In order to give professional holistic treatments, Help Mind Body will need to ask for and keep information about your health. Help Mind Body will only use this for informing holistic treatments and any advice Help Mind Body gives as a result of your treatment.
   2. The information to be held is:
      1. Your contact details
      2. Medical history and other health-related information (which Help Mind Body will take from you at the first consultation)
      3. Treatment details and related notes (which Help Mind Body will take after each consultation)
      4. Help Mind Body will NOT share your information with anyone else (other than within my own practice, or as required for legal process) without explaining why it is necessary and getting your explicit consent. 
          
4. How Long Help Mind Body Retain Your Information for
   1.  Help Mind Body will keep your information for the following periods: FHT requirements to retain information for 10 years. (Law regarding children’s records (records to be kept until the child is 25 or if 17 when treated, then 26). Your data will not be transferred outside the EU without your consent.          
       
5. Protecting Your Personal Data
   1. Help Mind Body is committed to ensuring that your personal data is secure. In order to prevent unauthorised access or disclosure, Help Mind Body has put in place appropriate technical, physical and managerial procedures to safeguard and secure the information we collect from you.
   2. Help Mind Body will contact you using the contact preferences you give me in relation to: Appointment times, holistic information or information related to your health.
   3.   Your Rights GDPR gives you the following rights:
      1. The right to be informed: To know how your information will be held and used (this notice).
      2. The right of access: To see your therapist’s records of your personal information, so you know what is held about you and can verify it.
      3. The right to rectification: To tell your therapist to make changes to your personal information if it is incorrect or incomplete.
      4. The right to erasure (also called “the right to be forgotten”): For you to request your therapist to erase any information they hold about you. The right to restrict the  processing of personal information.
      5. The right to data portability: under certain circumstances you can request a copy of personal information held electronically so you can reuse it in other systems.
      6. The right to object: To be able to tell your therapist you don’t want them to use certain parts of your information, or only to use it for certain purposes. Rights in relation to automated decision-making and profiling.
      7. The right to lodge a complaint with the Information Commissioner’s Office: To be able to complain to the ICO if you feel your details are not correct, if they are not being used in a way that you have given permission for, or if they are being stored when they don’t have to be.
      8. Full details of your rights can be found at  https://ico.org.uk/for-organisations/guide-to-data-protection/guide-to-the-general-data-protection-regulation-gdpr . If you wish to exercise any of these rights, please use the contact details given above. If you are dissatisfied with the response you can complain to the Information Commissioner's Office; their contact details are at:  www.ico.org.uk.
          
6. THERAPIST’S RIGHTS
   1. Please note: if you don’t agree to your therapist keeping records of information about you and your treatments, or if you don’t allow them to use the information in the way they need to for treatments, the therapist may not be able to treat you. Your therapist has to keep your records of treatment for a certain period as described above, which may mean that even if you ask them to erase any details about you, they might have to keep these details until after that period has passed. Your therapist can move their records between their computers and IT systems, as long as your details are protected from being seen by others without your permission.      
       
7. DECLARATION
   1. I have seen this document and understand that you will hold and use my personal information, using it in order to provide me with the best possible treatment options and advice in line with the statements above.