Dr MDC Intake Form
Parent / Carer Name
GP Surgery Details
How did you hear about DrMDC?
I confirm that I have read and understand the Terms of Reference. I accept the terms and conditions of appointments with Dr Martha Deiros Collado, Clinical Psychologist.
Terms of Reference
I understand that my contact details will remain confidential to Dr Martha Deiros Collado, Clinical Psychologist, and that any personally identifiable information will be stored in accordance with GDPR and the data protection act.
I understand that, in the case of Dr Martha Deiros Collado having serious concern for my safety or the safety of any children or vulnerable adults she is obliged to break my confidentiality and inform the relevant family members or professional services.