Please Note: To merely change your preferences on receiving newsletters, practice updates and in-house marketing, or the preferred methods of contacting you, simply email me a message, and we will make the alterations. Thank you.

Choice 1. On-Line Presence Information Request

The request below quickly generates and sends a report of your information held about you on this site eg comments, email queries etc.
There is a two-step email verification needed from you for it to proceed.

GDPR Request

To request a GDPR report please submit your email address below. We will email you a confirmation link to verify you are the owner of the account.


Choice 2. On-Line Request ‘To Be Forgotten’

The request below allows you to quickly delete any accounts that you hold on this site.
There is a two-step email verification needed from you for it to proceed.

GDPR Account Deletion Request

To request your account deleted from our system please enter your email address below. We will email you a confirmation link to verify you are the owner of the account.


Choice 3. Data held about you ‘On Computer’ – as a patient of this clinic

Your patient details are not kept on the website – only securely on computer, or on EU GDPR compliant servers.
For this information you MUST download, complete and send in the form as shown below, and provide the required proof of ID stated.
From that date we are obliged to send you the information within 30 days.

The pdf document can be downloaded here: Data-Subject-Request-Form D Murgatroyd

DATA SUBJECT
ACCESS REQUEST FORM


Practice Name: Dr D Murgatroyd, Osteopath Southampton, Bournemouth and Poole

You have a right to receive a copy of the data/information we hold about you or to authorise someone to act on your behalf.  Please complete this form and provide proof of your identity. Your request will be processed within 30 calendar days on receipt of a fully completed request form with proof of identity.

Proof of identity: We require proof of your identity before we can disclose your personal data. Proof of your identity should include a copy of two documents such as your birth certificate, passport, driving licence, an official letter dated not older than 90 days to you at your address e.g. bank statement, recent utility bill or council tax bill. The documents should include your name, date of birth and current address. If you have changed your name, please supply relevant documents evidencing the change. No administration charge is applicable for your first request.

SECTION ONE

Title: Name of Data Subject:
Address:
City:
Postcode:
Day time telephone numbers:
Date of birth:

If you are not the data subject and you are applying on behalf of someone else,
please also fill in the extra details below.

Title: Your Name:
Address:
City:
Post Code:
Day time telephone numbers:
Date of birth:
What is your relationship to the data subject?

(e.g. parent, carer, legal representative)

Please provide Letter of authority [ ] or copy of Lasting or Enduring Power of Attorney [ ]

Evidence of parental responsibility [ ]  or other formal information enclosed [ ]

SECTION TWO

I am enclosing two items from the following, one of which is photographic as proof of my identity:

Birth certificate [ ]  Driving Licence [ ]  Passport [ ]

 An official letter to my address not older than 90 days [ ]

DATA SUBJECT’S DECLARATION

I certify that the information provided on this form is correct to the best of my knowledge and that I am the person to whom it relates. I understand that you are obliged to confirm proof of identity/authority and it may be necessary to obtain further information in order to comply with this subject access request.
Name:
Signature: Date:

ON BEHALF OF A DATA SUBJECT

I confirm that I am legally authorised to act on behalf of the data subject. I understand that you are obliged to confirm proof of identity/authority and it may be necessary to obtain further information in order to comply with this subject access
Name:
Signature: Date:

PERSONAL INFORMATION REQUESTED

Please indicate what information is sought and if possible any supporting details such as the year or the reason for the request:
Warning: Anyone who unlawfully obtains or attempts to obtain data is guilty of a criminal offence and is liable to prosecution.

DATA FORMAT

[ ] Please send the information in electronic format

[ ] I would like to receive this information by post*

[ ] I will collect the information in person

[ ] I will go through the information with a member of staff

* Please be aware that if information is posted, we will take every care to ensure that it is addressed correctly. However, we cannot be held liable if the information is lost in the post or incorrectly delivered or opened by someone else in your household. Loss or incorrect delivery may cause you embarrassment or harm if the information comprises of special category data.

Please send your completed form and proofs of identity to:
Dr D Murgatroyd, Osteopath

Avenue Clinic

76 Bedford Place

Southampton UK

SO15 2DF

 

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