Dr. Madri Verster Medical Practice

POPIA Consent Form

Consent to process personal information

Please read these POPIA consent terms before confirming your personal information with the practice.

  1. 1.I hereby grant my consent to Dr Madri Verster and her appointed processor to process my personal data for the purpose of any or all of the undermentioned actions, being the legitimate reason for processing and/or using my personal data.
  2. 2.I accept that my personal information will only be utilized for the purpose it was collected, that the information will only be retained for as long as is necessary and required by law, and that I have the right to view such information at that time, as well as request correction or deletion of my personal information held by the Practice.
  3. 3.I am aware that I may withdraw my consent at any time.
  4. 4.I herewith consent to Dr Madri Verster collecting and having access to my personal information.
  5. 5.I expressly consent to Dr Madri Verster collecting and processing this information for the purpose of rendering services to me as well as processing claims with my medical aid.
  6. 6.I expressly consent to Dr Madri Verster handing over any outstanding accounts to debt collection third parties.
  7. 7.I expressly consent to Dr Madri Verster and her administrative staff having access to my personal information contained in my health record, including any clinical notes to process claims to my medical aid, issuing documentation or any other administrative function required by my health care practitioner.
  8. 8.I expressly consent to Dr Madri Verster using my personal information to communicate with me in person via telephone, email, video call, WhatsApp or any form of social media.
  9. 9.I expressly consent that the Management Group/Society to which Dr Madri Verster belongs be provided with such of my personal health information to enable them to render certain administrative services including coding queries, billing issues and audit assistance.
  10. 10.I express consent that Dr Madri Verster may discuss any of my personal health information with any of the other members of the clinical team that may at any stage of my treatment be involved in providing health care services to me and to forward any such information to the referring health care practitioner.