GDPR Consent Form for Herbalists
Data Protection Consent Form
Use this template to ensure compliance with data protection regulations.
Data Controller Information
Practice Name: _______________________
Practitioner Name: _______________________
Address: _______________________
Email: _______________________
Client Information
Name: _______________________
Email: _______________________
Date: _______________________
What Data We Collect
To provide herbal consultation services, we collect:
- Personal identification (name, date of birth, contact details)
- Health information (medical history, conditions, medications)
- Lifestyle information (diet, exercise, sleep)
- Consultation notes and recommendations
Why We Collect This Data
- To provide safe herbal recommendations
- To maintain accurate consultation records
- To identify contraindications
- To track progress
- To comply with legal requirements
How We Protect Your Data
- Paper records kept in locked storage
- Electronic records password protected
- Access limited to necessary personnel
- Data not shared without consent
Data Retention
- Active clients: Duration of relationship
- Inactive clients: 7 years after last consultation
- Records then securely destroyed
Your Rights
You have the right to:
- Access your personal data
- Request correction of inaccurate data
- Request deletion (subject to legal requirements)
- Withdraw consent at any time
Consent
☐ I consent to the collection and processing of my personal and health data for herbal consultation purposes.
☐ I understand I can withdraw consent at any time.
☐ I have been informed of my rights regarding my data.
Optional:
☐ I consent to receiving appointment reminders.
☐ I consent to receiving newsletters about herbal topics.
Client Signature: _______________________
Print Name: _______________________
Date: _______________________
