Appointments Archives - Breakspear Medical

Patient forms

November 4, 2025
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Appointments

Please complete the following forms: Adult treatment consent form Paying for your treatment Patient record card Supplement & medication list Medical questionnaire

Adult treatment consent form

November 4, 2025
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Appointments, Forms

Welcome to Breakspear Medical Thank you for choosing us for your healthcare needs. We're pleased to welcome you to our clinic and look forward to supporting you on your healthcare journey. Secure & confidential Your privacy is our priority. This medical questionnaire is protected by our HIPPAtizer programme, ensuring all your personal and medical information is securely encrypted and HIPAA-compliant…

Paying for your treatment

November 4, 2025
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Appointments, Forms

Welcome to Breakspear Medical Thank you for choosing us for your healthcare needs. We're pleased to welcome you to our clinic and look forward to supporting you on your healthcare journey. Secure & confidential Your privacy is our priority. This medical questionnaire is protected by our HIPPAtizer programme, ensuring all your personal and medical information is securely encrypted and HIPAA-compliant…

Patient record card

November 4, 2025
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Appointments, Forms

Welcome to Breakspear Medical Thank you for choosing us for your healthcare needs. We're pleased to welcome you to our clinic and look forward to supporting you on your healthcare journey. Secure & confidential Your privacy is our priority. This medical questionnaire is protected by our HIPPAtizer programme, ensuring all your personal and medical information is securely encrypted and HIPAA-compliant…

Supplement medication list

November 4, 2025
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Appointments, Forms

Welcome to Breakspear Medical Thank you for choosing us for your healthcare needs. We're pleased to welcome you to our clinic and look forward to supporting you on your healthcare journey. Secure & confidential Your privacy is our priority. This medical questionnaire is protected by our HIPPAtizer programme, ensuring all your personal and medical information is securely encrypted and HIPAA-compliant…

Medical questionnaire

October 1, 2025
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Appointments, Forms

Welcome to Breakspear Medical Thank you for choosing us for your healthcare needs. We're pleased to welcome you to our clinic and look forward to supporting you on your healthcare journey. Secure & confidential Your privacy is our priority. This medical questionnaire is protected by our HIPPAtizer programme, ensuring all your personal and medical information is securely encrypted and HIPAA-compliant…

Cookie	Duration	Description
cookielawinfo-checbox-analytics	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Analytics".
cookielawinfo-checbox-functional	11 months	The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional".
cookielawinfo-checbox-others	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Other.
cookielawinfo-checkbox-necessary	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookies is used to store the user consent for the cookies in the category "Necessary".
cookielawinfo-checkbox-performance	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Performance".
viewed_cookie_policy	11 months	The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. It does not store any personal data.