Enrolment Form

Enrolment Form


List current medication prescribed by your GP, and homely remedies that you may take.
I consent to Ashdale Care Ltd accessing all relevant information relating to my care provided in Ashdale and I accept that this may contain medical/clinical information about me/my relative.

I understand that information relating to me may be held electronically and that all personal data will be dealt with according to relevant Data Protection legislation and Ashdale’s General Data Protection Policy.

Information relating to me will be held in accordance with recommended legislative guidelines. I understand that Ashdale Care Ltd and its representatives employed by Ashdale Care Ltd, may need to contact and share with external third parties as necessary.

If you would like a relative or advocate to be involved in your care, please provide their details below:
These are my hopes and wishes regarding my future care and treatment should I become unable to make those decisions for myself.

I am aware that this is not a legally binding document.

If I lose the capacity to make decisions, I wish for this document to be used by others regarding my treatment and care.