Any information that we gather from your forms or appointment that can be associated with you, will remain confidential and will not be disclosed except to your referring practitioner or as per below.
For some appointment types sending a copy of the results and images obtained from your assessment at the Centre to your General Practitioner (GP/Family Doctor) is in the best interests of your health care.
If you permit CFEH to send a copy to your GP if appropriate, please provide their details below.
In addition to providing access to advanced eye imaging and assessment services, Centre for Eye Health is a valuable resource for research and teaching.
If you consent, any information will be presented in such a way that you cannot be identified.
Participation is voluntary. You may decide not to give us permission or withdraw your permission at any time.
Please feel free to ask us during your consultation. If you have any additional questions later, Michael Yapp, Head of Clinical Operations and Teaching (firstname.lastname@example.org or 02 8115 0700), will be happy to answer them.
By checking the box below, I consent to the use of any de-identified data acquired during my assessment for research and teaching purposes.
By signing this Patient Registration Form, I agree to abide by CFEH Patient Terms and Conditions. I also acknowledge that the information I have provided above is, to the best of my knowledge, accurate and complete and that I may be contacted by the Centre as needed.
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