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Consent Form

Please complete the following consent form:

First Name

Last Name

Covid-19 measures: I understand that if you are booking a face to face consultation be aware that Rosamund will take her temperature before entering your house. She will then ask to take your temperature and your partner's if present. I understand Rosamund will wear a mask if requested and she will wear gloves when handling baby or examining you.

Yes

No

I understand any personal infomration and consultation notes will be stored ona secure iCloud in line with GDPR (2018). HTat Rosamund is a registered midwfie with the Nursing and Midwifery Council (NMC) and is insured with Hiscox Insurance Policy No.PL-PSC10001981380/00. If I have any concerns with her practice i can contact the NMC.

Yes

No

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