Bosworth Health Suite & Pharmacy · Market Bosworth CV13 0JR
07946 606205 · emmacrawfordnutrition.co.uk
07946 606205 · emmacrawfordnutrition.co.uk
New Client Form
Client Consent &
Agreement Form
Agreement Form
Please read and complete this form before your first appointment. It covers consent for services, data protection, and any optional marketing permissions. Your medical information will be collected separately during your consultation.
Section 1 of 5
Personal Details
Your basic contact information — used to create your client record.
Section 2 of 5
Service Consent
Please read each statement carefully and tick to confirm your agreement.
Emma Crawford Nutrition is a private nutrition consultancy. Services are provided by Emma Crawford, RSPH Qualified & Registered Nutrition Consultant, fully insured. Nutrition consultancy is not a medical service and does not replace advice from your GP or other healthcare professionals.
Section 3 of 5
Data Protection & Privacy
How your personal information is collected, stored, and used.
Your data is health data — the most sensitive category under UK GDPR. Emma Crawford Nutrition takes your privacy extremely seriously. Please read this section carefully.
What data we collect: Name, contact details, date of birth, health and medical information, screening results, consultation notes, and payment records.
Why we collect it: To provide safe, personalised nutrition consultancy and to maintain accurate clinical records.
How long we keep it: Client records are retained for 7 years following your last appointment, in line with UK health record guidance, after which they are securely deleted.
Who can access it: Only Emma Crawford. Your data will never be sold or shared with third parties without your explicit consent, except where required by law.
Third-party processing: This form and some communications are processed via Formspree (formspree.io), a US-based service operating under GDPR-compliant data processing agreements. Appointment booking may use third-party scheduling tools. Your data is transferred securely.
Your rights: You have the right to access, correct, or request deletion of your data at any time. Contact emma@emmacrawfordnutrition.co.uk to exercise your rights.
Why we collect it: To provide safe, personalised nutrition consultancy and to maintain accurate clinical records.
How long we keep it: Client records are retained for 7 years following your last appointment, in line with UK health record guidance, after which they are securely deleted.
Who can access it: Only Emma Crawford. Your data will never be sold or shared with third parties without your explicit consent, except where required by law.
Third-party processing: This form and some communications are processed via Formspree (formspree.io), a US-based service operating under GDPR-compliant data processing agreements. Appointment booking may use third-party scheduling tools. Your data is transferred securely.
Your rights: You have the right to access, correct, or request deletion of your data at any time. Contact emma@emmacrawfordnutrition.co.uk to exercise your rights.
Section 4 of 5
Photography & Testimonials
Completely optional — please only tick what you are comfortable with.
These permissions are entirely voluntary and will not affect the quality of care you receive. You can withdraw any permission at any time by emailing emma@emmacrawfordnutrition.co.uk.
Section 5 of 5
Declaration & Signature
Please read the declaration below, then sign to confirm your agreement.
Declaration: I confirm that the information I have provided in this form is accurate and complete to the best of my knowledge. I have read and understood the service terms, data privacy information, and consent statements. I understand I can update my information or withdraw consent at any time by contacting Emma Crawford Nutrition.
Sign below using your mouse or finger:
Type your full name as your signature:
By typing your name you confirm this acts as your electronic signature.
Consent Form Submitted
Thank you — your consent form has been received and saved to your client record. Emma will be in touch to confirm your appointment details.