New Patient Registration & Agreement | Kinvara Private Hospital

Your privacy is protected: We will never use your phone/email for marketing or share them with third parties without your permission.

NHS Number *

10 digits. You can find it on any letter from the NHS, on a prescription, or in the NHS App.

I would like a chaperone to be present during physical examination? *

Yes, (I understand it is my responsibility to inform Reception of my requirement upon arrival)No

I understand my Consultant will update my GP about my treatment. I consent to this communication. *

YesNo

I consent to medical photos/videos being used for my treatment, training, and publication with my identity protected. *

YesNo

Agreements *

I consent to the collection, storage, and use of my medical information for diagnosis, treatment, and healthcare management in accordance with GDPR and our Privacy Policy.I confirm that the information I have provided is accurate and complete. I will inform Kinvara Private Hospital of any future changes to this information, including changes to my medical history, medications, or contact details.I accept the Privacy Policy and consent to Kinvara Private Hospital processing my personal data.