Patient consent form for recording consultations

Please fill in all fields marked with *

At The Ortho Practice, we record consultations using secure and compliant professional software to ensure accurate documentation of treatment discussions, recommendations, and your questions. These recordings help us maintain precise clinical records to provide our team with an accurate reference of what was discussed during your consultation, and allow us to continuously improve the quality of care we deliver.

By checking the ‘Yes – I consent’, I acknowledge and consent on my behalf, or on behalf of the person who has authorised me to provide consent, to the following:

• The Ortho Practice collecting my personal information (including sensitive and health information) through the recording of my consultation for the purpose of maintaining precise clinical records;
• The Ortho Practice using and disclosing my personal information (including sensitive and health information) for the purpose of maintaining accurate documentation of treatment discussions; and
• The Ortho Practice disclosing my personal information (including sensitive and health information) to third parties, such as Gong.io Inc, so that these third parties can securely store consultation recordings on The Ortho Practice' behalf.

Recording will involve the collection of your personal and health information through sound recording.

All recordings will be securely stored by our service provider, Gong.io Inc, on cloud servers in the United States. Our service providers will only access the recordings to provide technical support and system maintenance. More information about Gong.io Inc's privacy practices is available at: FAQs: Security, Privacy and Compliance

To learn more about how we handle your personal information, how to request access to, or correction of, your personal information, how to make a privacy complaint and how we will deal it, please view our Privacy Policy at Gong Privacy Policy or contact the team at Reception.

You are not required to agree to the recording of your consultations, and if you do not agree, it will have no impact on the provision of our services to you.

By submitting this form, you are agreeing to our privacy policy.