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Please be aware that if you send me any sensitive medical/health information, I will only hold and use this if we proceed to treatment, at which time I will require explicit consent from you to hold this data. If we do not proceed to treatment I will erase this information.

I understand that you will hold and use my personal information, using it in order to provide me with the best possible treatment options and advice in line with the statements above.

I consent to my submitted data being collected and stored.