Baseline form

Please take a few moments to reflect on how things feel right now following your first appointment. This will help us build a clear picture of a baseline which we can compare against later.

Full name

Date of birth

This helps us match you to the right record.

I agree to my answers forming part of my chiropractic clinical record, as set out in the Privacy policy and Terms & conditions

How we use this information

Lumina Chiropractic is the data controller for the information given here. Your answers, including health information, form part of your chiropractic clinical record and are held securely in Practice Hub, our practice software, alongside your notes and files.

We use your answers to plan, deliver and review care. We process this as part of our agreement to provide you with care (UK GDPR Article 6(1)(b)), and health information, which is special category data, because it is necessary for the provision of health care by a registered health professional bound by a duty of confidentiality (Article 9(2)(h)).

In line with General Chiropractic Council guidance, clinical records are kept for a minimum of eight years after the last appointment. We never sell your answers or use them for marketing.

You can ask to see, correct, restrict or object to the use of this information by emailing hi@luminachiropractic.co.uk or calling 07301 366 743. You may also complain to the Information Commissioner's Office at ico.org.uk. Full details are in our privacy policy and terms & conditions.