Digital Intake & Consent

Cotswolds Aesthetics Clinic · Dr. Laura B.

UK Medical / GDPR

01 Client Identification

Full Legal Name

Mobile Number

Date of Birth

02 Medical History & Contraindications

03 Declaration & Informed Consent

I hereby confirm that the medical history provided above is accurate, complete, and true to the best of my knowledge. I understand the nature, potential side effects, and aftercare recommendations for today's treatment. I authorise Auto-Admin client records to store this signed verification in compliance with UK GDPR and clinic insurance requirements.

04 Signature & Verification

Sign above with finger, Apple Pencil, stylus or mouse

✓

Consent Waiver Signed & Logged

Your digital intake record has been cryptographically logged and attached to your client card.

Verification Certificate:

WAIV-2026-UK-8491

Client: Sophie Laurent

Timestamp: Today, 11:02 AM

GHL CRM Tag: + waiver_signed (Sync Active)