Client Information

My website is protected by a SSL certificate which protects your information. Your information is stored inline with GDPR and processed according to the rules set out therein. Please download and read the Client information PDF document and keep safe for future reference.

If you have any concerns, please send me an email hello@wendieralphs.com

Client Information PDF

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About You

Your Name(Required)

First Last

Please select the pronouns you use

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Your Address

Street Address Address Line 2 City Postcode

How Can I Reach You?

Consent - (in line with the new General Data Protection Regulations (2018)) As the processing of your personal data is required to enable me to provide you with a service, I do not require consent from you to hold your information securely or to provide you with this service, but will take this opportunity to assure you I adhere to all laws and procedures relating to data protection (Article 9,paragraph 2, (h) of the GDPR) and will only use your data to provide you with this service and for any further reason you explicitly consent to below.

You can use my details to contact me about the following:

Appointment Reminders

Appointment Rearrangements

Evaluation of Services

Your Email Address(Required)

Your email address should be autopopulated - if not please send me a quick message.

Mobile Phone

Home Phone

Preferred Method of Contact

Date of Birth

Doctor's Details

GP Name

GP Address

Street Address Address Line 2 City Post Code

GP Phone Number

I agree and confirm that by typing my name in the box below, signing in the box and submitting this form, I have read and understood all the information detailed in the Client Information PDF supplied to me as a download at the top of this page and that I agree to abide by the terms and conditions outlined therein.

I agree, too, I am responsible if I do not follow the advice given or use the information supplied appropriately. In addition, I also give my permission for Wendie Ralphs to contact the appropriate external agencies in line with the above confidentiality policy.

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