My Authorisations

Please complete authorisation form below:

Please read the below information carefully and submit your authorisations.

You can alter your personal data preferences or unsubscribe from the service at any time by sending an email to emerald.bbmuk@bbraun.com.

If you would like to understand more about how we use your personal data, please go to our Privacy Policy.

1. Data Protection Act 2018 and UK General Data Protection Regulation (GDPR)

In order to provide you with the Emerald Prescription Service, we need to keep a record of certain items of your personal data. This includes your name, address, referring hospital, nurse or doctor's name and prescription details, as well as other specific information necessary to enable us to meet your requirements. Your personal data will be collected and stored in accordance with the requirements of the Data Protection Act 2018 and UK GDPR. Please see our detailed Privacy Policy. You can alter your personal data preferences or unsubscribe from the service at any time by sending an email to emerald.bbmuk@bbraun.com.

If you consent to us holding and using your personal data in this way:

Tick box 1 "Data Protection Act 2018 and UK GDPR"

2. Prescription delivery and electronic prescription service

Emerald is a free prescription delivery service (subject to exemption) for ostomy and continence supplies. Emerald can collect your prescription from your prescriber on your behalf and deliver your items to your home.

If you consent to us collecting and delivering your regular prescriptions in this way:

Tick box 2a "Prescription delivery service"
Enter your current address

If your GP offers an electronic prescription service, Emerald can receive your prescription electronically. This service saves time and offers more convenience to you.

If you would like to nominate Emerald to electronically receive your prescription:

Tick box 2b "Prescription delivery service"

3. Delivery text alerts

Our delivery company offers a text messaging service to our customers to make the delivery of prescription items more convenient.

If you consent to the delivery company using your mobile telephone number in this way:

Tick box 3 "Delivery text alerts"

4. Emerald text alerts

We offer a text messaging service to send you updates about your prescription and as a reminder to place your regular monthly order, with the option to order simply by replying to the message. We audit your stock levels regularly to ensure you have just the right amount to suit your needs. We also provide a text messaging service which updates you on our products and services, order and account information, invites to webinars and educational events, and to gain feedback from you as one of our valued service users.

If you consent to the Emerald text alert service using your mobile number in this way:

Tick box 4 "Emerald text alerts"

5. Marketing communications

We would like to be able to contact you to update you about Emerald and other health care products, services, promotions and special offers.

If you consent to us using your personal data in this way:

Tick box 5a for marketing communications by post
Tick box 5b for marketing communications by email
Tick box 5c for marketing communications by text message

You are in control of what communicatioins you receive from us. If, in the future, you would like to change these options let us know by calling 0800 163 007 or emailing us at emeraldservice.bbmuk@bbraun.com and we will make sure you only get the messages you are happy to receive. If you would like to understand more about how we use your personal data, please go to our privacy policy.

I confirm I have read and understood the five points on this authorisation form.

Please tick the boxes below where you give consent to B. Braun Medical Ltd to do the following (the points with a * are mandatory to provide you with the service):

Data Protection Act 2018 & UK GDPR

1. I consent to you holding and using my personal data in accordance with the Data Protection Act 2018 and UK GDPR

Prescription delivery service

2.a Please collect my prescription from my GP and then deliver the items to the address listed below. I understand that Emerald will continue to provide this service until I give notification to stop.

Electronic Prescription Service

2.b I would like to nominate Emerald as my DAC for dispensing prescriptions issued by the NHS electronic prescription service.

Delivery text alerts

3. I consent to you providing your delivery company with the mobile number listed below so that they can send me text alerts when my items are due for delivery.

Emerald text alerts

4. I consent to you using the mobile number listed below to send a monthly reminder text and updates about my prescription and to send general updates, invitations to events and to gain feedback.

__________________________________

Marketing Communications:

I consent to you contacting and updating me about Emerald and other health care products, services, promotions, special offers and to participate in feedback and evaluations:

5a. by Post

5b. by Email

5c. by Text message

__________________________________

Name

Address

Postcode

Telephone/ Mobile

__________________________________

If you are completing this information on behalf of the patient, please provide your personal information below:

Name

Telephone/ Mobile

Relationship to patient (Eg. Carer, wife, husband)

My Authorisations

Please complete authorisation form below:

1. Data Protection Act 2018 and UK General Data Protection Regulation (GDPR)

2. Prescription delivery and electronic prescription service

3. Delivery text alerts

4. Emerald text alerts

5. Marketing communications

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