Consent Form — General template

1. Nature of Services

• I understand that the services provided will be explained to me before they begin, including their purpose, what to expect, and any preparation required. I may ask questions at any time.

2. Risks and Benefits

• As with any service, there may be risks, discomforts, or limitations, as well as potential benefits. No specific outcome is guaranteed, and results vary between individuals.

3. Voluntary Participation

• My participation is voluntary. I may decline any part of the service or withdraw my consent at any time without affecting my right to future care, except where safety requires otherwise.

4. Confidentiality and Data Protection

• My personal and health information will be kept confidential and handled in accordance with the UK GDPR and Data Protection Act 2018, and shared only with my consent or as required by law.

5. Fees and Cancellation

• Fees will be communicated in advance. I agree to give at least 24 hours' notice to cancel or reschedule; late cancellations may incur a charge.

Client Information

• Full NameText
• Date of BirthDate
• AddressText
• Phone / EmailText

Provider Information

• Provider NameText
• Role / Licence No.Text

Emergency Contact

• Contact NameText
• Relationship / PhoneText

Acknowledgment and Signature

• Client SignatureSignature
• Date signed (client)Date
• Provider SignatureSignature
• Date signed (provider)Date

• By signing below, I confirm I have read and understood this form and voluntarily consent to receive services.