We’re ready to get your patient started – we just need a little bit of information. To help us support your patient safely and effectively, please complete all fields.
The Date of Birth above would suggest that the patient is under 18, please enter the details of the Parent / Guardian below.
Please confirm by ticking the box below that the Health Care Professional has informed the individual that their personal data will be shared with us to allow myQufora support, and obtained the individual's consent**. If consent is not provided the patient will receive the Qufora product but it will not be possible for the patient to receive the myQufora support:
For more information on how Qufora Direct and Qufora UK share and use personal data, the individual can view the Qufora Direct and Qufora UK privacy policies here Privacy Policies[insert link to both privacy policies].
** Qufora UK requires consent from the patient to use their personal data to effectively provide continuous care and support through myQufora. This consent is also necessary for Qufora UK's NHS registered delivery partner, Rapidcare (operating as Qufora Direct) to share patient details (including initial order and any re-order details) with the myQufora support team to enable the myQufora support to be provided. Qufora UK and Qufora Direct are committed to protecting patient privacy and keeping all patient data secure. The patient can withdraw consent at any time by contacting Qufora UK or Qufora Direct however if consent is withdrawn, myQufora support would no longer be provided.
