Name of person (young person) due for testing *

First Name

Last Name

Consent form *

I give consent to participate (or my child to participate) in concussion related testing at the chosen testing site.

Yes

*

I have read and understood the privacy policy notice and terms & conditions (found on the services page) on this website and have no further questions.

Yes

*

I give consent for my testing data (or my child's testing data) to be stored safely, with the assessing and treating clinician. You (or your child's) data will only be used in accordance with our privacy policy.

Yes

*

I understand that a concussion is a medical diagnosis and must be made by a physician. Our testing services are carried out by registered healthcare professionals who can form a clinicial impression, and provide support on this basis. This does not replace a clinical diagnosis, and where appropriate, medical advice should be sought. Our clinicians will discuss this with you or your child, should the instance arise. I understand and agree to package purchase under these terms.

Yes

*

I agree to the terms of sale (outlined in the terms and conditions section)

Yes

Data sharing *

As part of our commitment to transparency and data protection under the UK General Data Protection Regulation (UK GDPR), we would like to ask for your optional consent regarding the potential sharing or sale of your anonymised data. Your anonymised data (which cannot be used to identify you) may be of interest to third parties, such as researchers, health organisations, or commercial partners, for purposes including academic research, healthcare innovation, or product development. Please note: This is entirely optional and your participation in testing will not be affected by your decision. You can withdraw your consent at any time without giving a reason. Any data shared or sold will be anonymised and will not contain your name, contact details, or any other information that could directly identify you. Do you consent to your anonymised data being shared or sold to approved third parties for research and development purposes?

Yes, I consent to my anonymised data being shared or sold to third parties.

No, I do not consent to my anonymised data being shared or sold.

I do not wish for my data to be sold, but would be happy for my data to be utilised for research purposes (your data will always be anonymised)

SIGNED *

Signed name (Responsible adult if young person is under the age of 16). By signing this consent form and contract, you agree to the T&Cs, Privacy policy and fees for services.

First Name

Last Name