The Precision Nutrition Clinic®

The Precision Nutrition Clinic®

CLIENT CARE

Client Consent Form

Client Consent Form

Client Consent Form

To be completed before or at your first session. This form covers your consent to receive dietetic care and how your information is used.

Before you begin

Each section is separate — you can say yes to some and no to others. You can change your mind later by emailing support@theprecisionnutritionclinic.com. This form contains health information, so please complete it in a private setting.

Your details

Your details

Please use the details you would like us to use for your care and appointment communications.

Full name

Date of birth

Email

Phone

Address

GP name and practice (optional)

Emergency contact (optional)

Confirming you’re able to consent

Confirming you’re able to consent

I confirm I am 18 years of age or over.

Consent to dietetic assessment and advice

Consent to dietetic assessment and advice

I consent to receiving a nutritional assessment and personalised dietetic advice from Sal, Registered Dietitian. I understand this service is based on the information I provide and does not replace diagnosis or treatment from a doctor. I will continue to see my GP or specialist for anything outside the scope of dietetic advice, and contact 999 or A&E in an emergency.

I consent to dietetic assessment and personalised advice.

Consent to process your health information

Consent to process your health information

Your health information, including medical history, diagnoses, medications, and dietary information, is special category data under UK GDPR. We only collect and use it to provide your nutrition care, as set out in our Privacy Policy.

Read the Privacy Policy

I consent to The Precision Nutrition Clinic collecting and using my health information for my nutrition care.

Consent to contact you

I consent to being contacted by email and/or phone or text for appointment reminders, plan updates, and service communications. Standard email and text messages are not fully secure channels, so let us know if you would rather we avoided sending sensitive health details this way.

I consent to being contacted for appointment and service communications.

Preferred contact method

Email

Phone

Text

Consent to liaise with your GP or other healthcare professionals

Consent to liaise with your GP or other healthcare professionals

Please choose whether we may contact your GP or another healthcare professional when relevant to your care. We will only share information that is genuinely useful and will ask for specific consent where needed.

Yes — you may contact my GP or other healthcare professionals when relevant to my care.

No — please do not contact anyone else on my behalf without asking me first each time.

GP or specialist name and practice (optional)

Consent to use your feedback

Consent to use your feedback

This is optional and unrelated to your care. Your choice will not affect the support you receive, and you can change your mind at any time.

I’m happy for The Precision Nutrition Clinic to use my feedback as a testimonial.

I’d prefer my feedback isn’t used publicly.

Terms acknowledgement

Please read the Terms of Service and Refund & Cancellation Policy before submitting this form.

Read the Terms of Service

Read the Refund & Cancellation Policy

I’ve read and understood the Terms of Service and Refund & Cancellation Policy.

Declaration

Declaration

I confirm the information I’ve given is accurate to the best of my knowledge, and that I’ve had the chance to ask questions before signing.

Client signature

Print name

Date

Practitioner signature

Practitioner date

Your responses will be handled in line with the Privacy Policy. Please email support@theprecisionnutritionclinic.com if you need to withdraw consent or correct anything after submitting.

Submit consent form

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