• MSTC Registration Form

    In order to access our Oxygen Therapy or Physio Sessions, we need you to provide us with some personal and health related information. This is important as it enables us to assess your individual needs and provide you with the most appropriate and suitable therapies. We have endeavoured to keep the information we request from you to the minimum necessary.
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  • IMPORTANT: The Parent/Guardian of children (under the age of 13 if appropriate) must complete this form in order to access our Support Services and Therapies. We need you to provide us with some personal and health related information. This is important as it enables us to assess your child’s individual needs and provide him/her with the most appropriate and suitable therapies. We have endeavoured to keep the information we request from you to the minimum necessary.  

  • Your Personal Information

    Please fill in your details below

  • Your Personal Information

    Please fill in your child's details below
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  • Parent/Guardian Information

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  • Your Circumstances

  • Next of Kin/Emergency

  • Your Carer Information

  • Your Health Information

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  • CARE Package

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  • Your Medical Information

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  • Oxygen Therapy

    If you wish to access our Oxygen Therapy service, please complete the following:
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  • The MS Therapy Centre Lothian does not provide medical advice, diagnose health conditions or prescribe treatments. We base your access to, and engagement with oxygen therapy on the self-declared information you have provided us with. You suitability is based on the assessment of this information and the existing evidence and protocols within the field of oxygen therapy.

  • Physiotherapy

    If you wish to attend our Physio sessions, please complete the following:
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  • Accept & Agree Terms

    We require your CONSENT for specific aspects of what we do, please READ and CHECK the appropriate box/es. Thank You
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  • In accordance with the General Data Protection Regulation 2018, all personal, health and/or medical information (data) supplied to the MS Therapy Centre Lothian will be held in the strictest confidence and will not be passed on to any third parties without your consent. Your personal, health and/or medical information (data) will only be used for the purposes as outlined on our Privacy Policy/Statement. If you have any concerns regarding the way your information is stored or used by MSTC Lothian, then please contact the Data Controller as detailed below.

  • Contact Details:
    Data Controller, Nancy Campbell
    The MS Therapy Centre Lothian
    40c Swanfield
    Edinburgh
    EH6 5RX
    T: 0131 554 5384
    Email: nancy@mstc-lothian.org.uk

  • Further Information:
    The Information Commissioner's Office - Scotland
    45 Melville Street
    Edinburgh
    EH3 7HL
    Telephone: 0303 123 1115
    Email: Scotland@ico.org.uk

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