Consent Form for Contact Lens Purchase

Consent Form for Contact Lens Purchase

BY submitting the prescription form(s) and/or other document(s) to Capitol Optical Company (Private) Limited, I hereby consent to the collection, use and/or disclosure by Capitol Optical Company (Private) Limited of my personal data which may include medical or health data of a sensitive nature.

In addition to the purposes set out in Capitol Optical’s Privacy Policy, I acknowledge and agree that the personal data which I have provided may be collected, used and/or disclosed by Capitol Optical Company (Private) Limited for or in connection with any of the following purposes:

  1. to facilitate and/or complete any purchase(s) on this website;
  2. to facilitate Capitol employee(s) to contact patient and invite patient in-store to do a complimentary eye health check if necessary to update Capitol Optical Company (Private) Limited health records.
  3. to facilitate and/or complete any future purchase(s) on this website; and/or
  4. to check and make enquiry with any relevant parties, including ophthalmic lens manufacturers, contact lens manufacturers, frame manufacturers, medical clinics and/or hospitals, for the purposes of facilitating and completing any purchase(s) on this website.

I acknowledge and agree that this Consent Form will be effective from the date that I submit the prescription form(s) and/or other document(s) to Capitol Optical Company (Private) Limited, and will remain effective until the date that I notify Capitol Optical Company (Private) Limited of my intention to withdraw my consent.*

*Please note that you have a right to withdraw your consent for the collection, use and/or disclosure of your personal data at any time. Simply refer to Capitol Optical’s Privacy Policy which sets out the procedure to request for your personal data to be erased.

 

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