The information in this switch clinic form is being collected by easykind to assess your eligibility for discounted services and to enable communication with you.

• You do not have to provide us with this information. However, failure to do so may affect our ability to provide you with a discounted consultation.

• The information will be accessed by the patient onboarding team and may be used to assess your suitability for the clinic and a discounted rate, and to facilitate your access to and use of our services, including when booking consultations for you. It may be shared with and used by healthcare professionals involved in your care, such as doctors, nurse practitioners, registered nurses or pharmacists. We may also use this information to contact you with discounts or special offers.

• The information in this switch clinic form may be stored in secure, cloud servers located in the United States of America.

• By completing this switch clinic form you agree to your information being used and disclosed according to our Privacy Policy and this collection notice.

• Please refer to our privacy policy for more details for further information about how your data may be used or disclosed.