Video Group Clinic Patient Agreement

By participating in this video group clinic (VGC) I agree that:

1. I am happy to share some information about my condition that relates to the group’s topic. For those participating in the diabetes clinic this would include the results from my latest blood test:

- HbA1c (diabetes)

- Cholesterol profile

- Kidney Tests

- Liver tests (only the ALT as this has relevance to weight loss)

- Medication I take (only ones to treat diabetes, cholesterol and high blood pressure will be included)

These results will be shared with the group on a “results board” to support group discussion and my learning. I will be given the opportunity to have a discussion about my concerns. Other members of the group will listen in, and in turn I will listen to their one to one discussion, so that we can all benefit from hearing and understanding common problems and solutions.

2. I am under no obligation to share any other personal information with the group unless I choose to do so and that if I have health concerns I don’t want to discuss in the group setting, I may ask to discuss them privately in a 1:1 consultation.

3. At any time, I can withdraw my consent to participate in the video group clinic and book a 1:1 consultation.

4. All information I learn about group members is confidential. I agree that I will record nor share any information about other members of the group in conversations outside the group, or on social media such as Facebook, Twitter etc or in any other public forum.