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Medical Questionnaire

Our medical questionnaire is to collect the information required in order for you to have a safe experience with our professional guidance. Please feel free to share any additional information you deem is relevant to disclose. Thank you for your co-operation.

Medical Questionnaire

PERSONAL INFORMATION

EMERGENCY CONTACT INFORMATION

MEDICAL HISTORY

* Please answer as accurately as possible. This knowledge is important to ensure your safety and the safety of others while participating

PSYCHOLOGICAL INFORMATION

* Please answer as accurately as possible. This knowledge is important to ensure your safety and the safety of others while participating.

DIETARY REQUIREMENTS AND ALLERGIES

ADDITIONAL INFORMATION

AGREEMENT AND INFORMED CONSENT

Confidentiality Statement

We deploy all efforts to protect the private nature of your personal information. Since we collect information about you using our website and through our email communication, we feel that it is important that you understand how we collect and use this information. The below summarises our personal information collection practices.

Personal Information Collection

All personal information collected by johnpattoncurandero.com is done so exclusively with your consent, by means of a form posted on our website, an email attachment. No information is collected automatically.

Use of your Personal Information

The personal information collected is only used by our team for the purposes defined at the time of the collection or a use that complies with these purposes. Physical documents are stored safely and we do not share your information with any third parties.
As mentioned above, we use your personal information to appropriately process your appointment requests and present you with the information you need to access.

Sharing of your Personal Information

We will not, in any circumstances, share your personal information with other individuals or organizations without your permission, including public organizations, corporations or individuals, except when applicable by law. We do not sell, communicate or divulge your information to any mailing lists.