CONSENT
 
Your consent is required before you can complete the online health assessment. If you choose not to accept these terms, you will not be able to use the Health Risk Assessment (HRA) and schedule the appointment online.

Please read this Consent Form carefully before giving consent. The following information will be collected on the HRA: Name, date of birth, gender, address, email, mobile number, medical history and information concerning health behaviors and lifestyle habits. Information given to us is stored on secure servers with policies and procedures to maintain the safety and security of that information.

By signing this Consent Form, I acknowledge and agree that: