Video Group Clinic Patient Consent Form

You are booked onto a video group clinic session. To help keep you safe during the session and so we can contact you if we need to, we need some information. We will also use some of this information at the start of the session to confirm your identity and make sure that if you do need help during the session, we can get help to you. 

By participating in this video group clinic (VGC) I agree that:

1. I am happy to share some information about my condition that relates to the group’s topic. For example, this might include my average blood sugar readings, peak flow meter readings, my blood pressure or cholesterol levels etc. These results will be shared with the group on a “results board” to support group discussion and my learning. I will then have a one to one discussion about my concerns. Other members of the group will listen in, and in turn I will listen to their one to one discussions, so that we can all benefit from hearing and understanding common problems and solutions.

2. I am under no obligation to share any other personal information with the group unless I choose to do so and that if I have health concerns I don’t want to discuss in the group setting, I may ask to discuss them privately in a 1:1 consultation.

3. At any time, I can withdraw my consent to participate in the video group clinic and book a 1:1 consultation.

4. All information I learn about group members is confidential. I agree that I will record nor share any information about other members of the group in conversations outside the group, or on social media such as Facebook, Twitter etc or in any other public forum.

If you have any questions about the video group clinics, please watch our video or read our frequently asked questions.