Purpose of voluntary consent
I hereby request and consent to the performance of Acupuncture treatments and other procedures within the scope of the practice of Acupuncture on me, on my child, a child that is in my care, or on the patient for whom I am legally responsible.
I hereby voluntarily consent to be treated with Acupuncture by Glenn Delikan. I understand that I may be treated with the application of insertion of sterile acupuncture needles and/or finger pressure and/or the application of heat to the skin and/or Cupping/Gua Sha and/or Chinese dietary therapy.
I understand that the practice of Acupuncture is not an exact science and there are no guarantees that have been made to me as a result of treatment.
Possible side effects/ healing response
I have been informed that Acupuncture is a generally safe method of treatment, but that it may have some side effects including: bruising, numbness or tingling near the needle sites that may last a few days and dizziness or fainting. Burns and /or scarring are a potential risk of Moxibustation and Cupping, or when treatment involves the use of heat lamps. Bruising is a common side effect of cupping. Unusual risks of Acupuncture include: spontaneous miscarriage, nerve damage and organ puncture, including lung puncture (pneumothorax). Infection is another possible risk, although sterile disposable needles are used with all patients to maintain the safest and most sterile treatment environment possible.
I do not expect the clinical staff to be able to anticipate and explain all possible risks and complications of treatment, and I wish to rely on the clinical staff to exercise judgment during the course of treatment, based upon the facts then known is in my best interest. I understand that results are not guaranteed.
I understand the clinical and administrative staff may review my patient records, but all my records will be kept confidential and will not be released without my written consent.
I understand that if there is a worsening of my ailment or condition, or if it does not improve within the time estimated by my practitioner, or if a new ailment or condition arises, that I should consult my GP. If you request that Glenn Delikan discuss or share his records of your case with another healthcare provider he will gladly do so provided that you have given him written permission. This is a professional standard among all licensed healthcare providers.
Infectious Disease/ Clean Needle Procedure
I understand that infectious organisms can be carried through the air, through physical contact, and through body fluids. I understand that my Acupuncture practitioner uses Universal Precautions to guard against the spread of infection. I understand that Glenn Delikan follows strict clean needle procedures. Only sterile, single-use disposable Acupuncture needles are used and are discarded in a biohazard container.
I understand that it is my responsibility as a patient to inform Acupuncturist practitioner Glenn Delikan about all aspects of my health and that as treatment progresses, to inform my practitioner of any changes that occur. I have carefully read and understand the above information. I am aware of what I am agreeing to and have felt free to ask questions.
CONSENT TO TREAT A MINOR CHILD
I authorise Glenn Delikan to administer Acupuncture as deemed necessary to my child or a child in my care.
Reasonable suspicion that the Clinic has been exposed to COVID-19 or other infectious diseases
If a person who has visited the clinic is diagnosed with Covid-19 within 14 days from my last contact with them I will take the following steps and precautions.
If myself or a staff member at any time had a proximity to this person under two metres or were exposed to a cough or sneeze, I will stay home for seven days from my last contact with them and only return to work if neither of the three cardinal symptoms of Covid-19 have not appeared (as defined in Appendix 2 of the BAcC guide to COVID-19).
If either myself or a staff member is diagnosed with Covid-19 under 14 days or less after non-socially distanced contact with a patient I later discover has also been diagnosed with Covid-19 in the same period, I will follow the HSE guidance regarding Covid-19 and RIDDOR (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013).
Additionally I will inform all patients who had been present during the suspected exposure period and cancel all future appointments until I have followed all the steps outlined in Section 3 of the BAcC guide to COVID-19.
If I have reasonable suspicion that the practice premises have been exposed to a person with a case of Covid-19, all access to the building must be suspended until a deep clean can take place.
This also applies if I am informed by other users of the premises that they have reasonable suspicion that the building has may have been exposed.
Updated September 2020
Using this website Terms & Conditions
Please read the information that follows carefully as it governs your use of this website
From your first visit to this site you agree to follow the terms and conditions below. If you do not accept these Terms and Conditions in full then please stop using this site.
This website and its information are provided on an ‘as is’ basis with no warranties of any kind whatsoever, either express or implied.
Use of this website and the information on it is entirely at the user’s sole risk.
In no event will Sanjuro Training Systems Limited (STS) (its products & services) be liable for any damages whatsoever arising out of or related to its websites.
Your sole and exclusive remedy for dissatisfaction with this and other STS websites, information &/or service contained is to stop using the sites, information and the service.
Sanjuro Training Systems Ltd does not warrant that the functions contained in this site will be uninterrupted or error free, or that defects will be corrected.
You must take your own precautions to ensure that the process which you employ for accessing this website does not expose you to the risk of viruses, malicious computer code or other forms of interference which may damage your own computer system.
We can’t accept any responsibility for any loss, disruption or damage to your data or your computer system which may occur whilst using material derived from this website.
You must not misuse our site by knowingly introducing viruses, trojans, worms, logic bombs or other material which is malicious or technologically harmful.
You must not attempt to gain unauthorised access to our site, the server on which our site is stored or any server, computer or database connected to our site.
You must not attack our site via a denial-of-service attack or a distributed denial-of-service attack.
By breaching this provision, you would commit a criminal offence under the Computer Misuse Act 1990. We will report any such breach to the relevant law enforcement authorities and we will cooperate with those authorities by disclosing your identity to them.
We don’t provide any guarantees, conditions or warranties as to the accuracy of the information on the site. We don’t accept liability for loss or damage incurred by users of the website, whether direct, indirect or consequential, whether caused by tort, breach of contract or otherwise.
This includes loss of: income or revenue, business, profits or contracts, anticipated savings, data, goodwill, tangible property or wasted management or office time in connection with our site or in connection with the use, inability to use, or results of the use of our site, any websites linked to it and any materials posted on it. This condition shall not prevent claims for loss of or damage to your tangible property or any other claims for direct financial loss that are not excluded by any of the categories set out above.
This does not affect our liability for death or personal injury arising from our negligence, nor our liability for fraudulent misrepresentation or misrepresentation as to a fundamental matter, nor any other liability which cannot be excluded or limited under applicable law.
Sanjuro Training Systems Limited, respects the privacy rights of its clients & visitors and recognises the importance of protecting their personal data. We will not ask for personal information.
Sanjuro Training Systems Limited products & services:
Fitt-in: We will, require school e-addresses and a primary contact name and contact number, school name and postal address, for use only to do with the Fitt-in product and its associated services.
By entering your email address for our mailing list/newsletter and/or ticking the opt in box for either the Fitt-in free trial or licence you agree to your data being stored, shared and used by Fitt-in & Sanjuro Training Systems Ltd
Rowing2Music: We will require your email address, name & contact telephone number
Glenn Delikan – Acupuncture: We will require your email address, name & contact telephone number – for full details please see the opposite column
Inclusion Coach training: We will require your email address, name & contact telephone number
Your data will be stored for purposes such as payments, SMS, email, hosting, security, telephony, support, auditing, evaluation, data analysis & generating reports, preventing or detecting fraud or error, and research to improve our service and customer communications.
Certain information is transmitted to servers by the Internet browser of each online visitor when they access the website, including the date and time of access, the name of the requested file, the referral webpage, the status (e.g. transaction completed), the Web browser and operating system used, the IP address of the device and the size of transmitted data. This information is stored in connection logs for a limited period of time for the purpose of ensuring the security and proper functioning of the website as well as for statistical purposes and Fitt-in report generation for each school.
Protecting your information
Under the General Data Processing Regulation (GDPR) & Data Protection Act 1998, we have a legal duty to protect any personal data we collect from you. Our Web Hosting & E-commerce packages use leading technologies and encryption software to safeguard personal data, and keep strict security standards to prevent any unauthorised access to it.
The legal basis for processing
Under Data Protection Law, there are various grounds which are considered to be a ‘legal basis for processing’.
The legal basis for processing should be determined by the Data Controller.
Where we are the Data Processor, the legal basis is determined by the Customer. Typically, the legal basis in this scenario is:
• ‘processing is necessary for the performance of a task carried out in the public interest’
Where we are the Data Controller, the legal basis for processing is based on:
• ‘processing is necessary for the purposes of legitimate interests pursued by the controller’
It should be noted that in some circumstances this legal basis may vary, however, we always operate in full compliance with Data Protection Law and will only process data with a fair and reasonable legal basis for doing so.
We will only retain information for as long as is necessary to deliver the service safely and securely. We may need to retain some records to maintain compliance with other applicable legislation – for example finance, taxation, fraud and money laundering law requires certain records to be retained for an extended duration, in some cases for up to seven years.
For further information on GDPR and your rights please visit:
Cookies may be placed on all our websites.
Cookies are small files downloaded to your computer. Cookies help us to ensure the safety and smooth functionality of our website (security cookies and session cookies) and to collect information about the products online visitors are interested in, as well as their navigation through our website.
If we use tracking cookies on our website, it is to help us learn how we can serve our customers as
best we can. These tracking cookies enable us to monitor how long you stay on a page, for example, or which pages you visit.
You can disable cookies or set your browser to alert you when cookies are being sent. Additionally you have the option to deactivate only tracking cookies. See below for more information.
The European Interactive Digital Advertising Alliance (EDAA) has developed the website Your Online Choices (www.youronlinechoices.eu). On this website you can find more information about your cookies, and manage them.
When you send an email or other communication, we may retain those communications in order to process your inquiries.
Fitt-in: We will only use your information to alert you that your free trial or licence is due to expire, Invoice detail, Information/posters to support usage within your school, update you on new products or offers, send weekly Fitt-in usage reports.
Sanjuro Training Systems Limited: we will use your information for invoice detail, reminders & updates on the classes & training, sending of E-posters to promote activity
Rowing2Music: we will use your information to alert you to updates
Inclusion Coach training: we will use your information for invoice detail, sending of training information/workbooks, reminders & updates on the training.
We will never knowingly sell on your information.
Please note that any feedback you leave on our pages is openly shared with people who are part of the Sanjuro Training Systems Limited network and outside of it.
Please always be respectful of people and copyright.
English Law applies.
All content on this website, including articles, artwork, screen shots, graphics, logos, digital downloads and other files, is the property of Sanjuro Training Systems Ltd, unless owned by a third party, and is protected by English copyright, trademark and other intellectual property laws.
Changes to our policies and terms and conditions
These Terms and Conditions shall be governed by the laws of England and Wales. The courts in England and Wales will have jurisdiction in respect of any dispute which may arise.
If any of these Terms and Conditions shall be determined to be illegal, invalid or otherwise unenforceable by reason of any state or country in which these Terms are intended to be effective, then to the extent and within which that Term is illegal, invalid or unenforceable, it shall be severed and deleted from these Terms and the remaining Terms shall survive, remain in full force and effect and continue to be binding and enforceable.
Sanjuro Training Systems Limited will strive to ensure that our products & services and websites are accessible to anyone regardless of circumstances or disability.
We regularly review our site and ask that users and clients send us questions or suggestions on how we can improve this website or our services/products
We will also, wherever possible, ensure our website and services can work across all platforms (mobile, desktop, tablet) and the most common browsers and operating systems. If you experience problems always check to ensure your browser software is up to date
Terms & Conditions when using the Fitt-in videos, Rowing2Music, Sanjuro Activity Classes & Acupuncture service
As with all physical activity, you must always check with your medical practitioner before starting anything new. If you feel unwell or have any injuries then you should seek medical advice prior to any physical activity.
When participating in any exercise, there is the possibility of physical injury. If you engage in Fitt-in routines & exercise using Fitt-in Videos, Rowing2Music, Sanjuro exercise classes, you agree that you do so at your own risk, are voluntarily participating in these activities, assume all risk of injury to yourself, and agree to release and discharge Fitt-in, Rowing2Music and Sanjuro Training Systems Ltd and its people, from any and all claims or causes of action, known or unknown. English Law applies.
Purpose of privacy notice
The processing of personal data is governed by the General Data Protection Regulation 2016/679 (the GDPR). This legislation will replace current data privacy law, giving more rights to you as an individual and more obligations to organisations holding your personal data.
One of the rights is a right to be informed, which means I have to provide you with information about the way in which I use, share and store your personal information.
This means that I will be publishing a new privacy notice so you can access this information, along with information about the increased rights you have in relation to the information I hold on you and the legal basis on which I am using it.
This new privacy notice comes into effect on 25 May 2018.
Who am I?
Glenn Delikan is an employee of Sanjuro Training Systems Ltd. A private limited company registered in the UK (04853259).
Glenn Delikan is the data controller. This means I decide how your personal data is processed and for what purposes.
Whose information does this privacy notice apply to?
This privacy notice applies to information I collect from:
• prospective patients;
• former patients;
I am required to keep these records for seven years from the date of the end of treatment.
ICO ref ZA480283 : https://ico.org.uk/ESDWebPages/Search
What is personal data?
Personal data relates to a living individual who can be identified from that data. Identification can be by the information alone or in conjunction with any other information in the data controller’s possession or likely to come into such possession. Examples of personal data I may hold about you include your contact and appointment details.
Special category data is a sub-category of personal data which includes racial or ethnic origin, political opinions, religious or philosophical beliefs, or trade union membership, and the processing of genetic data, biometric data for the purpose of uniquely identifying a natural person, data concerning health or data concerning a natural person’s sex life or sexual orientation. For my purposes, the special category of data I may hold about you is solely your patient notes.
How do I process your personal data?
I comply with my obligations under the GDPR by keeping personal data up to date; by storing and destroying it securely; by not collecting or retaining excessive amounts of data; by protecting personal data from loss, misuse, unauthorised access and disclosure and by ensuring that appropriate technical measures are in place to protect personal data. I use your personal data for the purposes set out below.
Sections 1 – 15 apply to my patients, prospective patients, former patients and visitors to my clinic
1 - I use your name, address, telephone number and email address to make and rearrange appointments. I are unable to send or receive encrypted emails so you should be aware that any emails I send or receive may not be protected in transit. I will also monitor any emails sent to me, including file attachments, for viruses or malicious software. Please be aware that you have a responsibility to ensure that any email you send me is within the bounds of the law.
2 - I will use your name, address, telephone number and email address, only if I have your explicit consent, to send you marketing materials. I am unable to send or receive encrypted emails so you should be aware that any emails I send or receive may not be protected in transit. I will also monitor any emails sent to me, including file attachments, for viruses or malicious software. Please be aware that you have a responsibility to ensure that any email you send me is within the bounds of the law.
3 - Some patients and prospective patients return pre- 1st appointment questionnaires or tell me about their medical conditions and medication by email or online enquiry forms. I are unable to send or receive encrypted emails so you should be aware that any emails I send or receive may not be protected in transit. I will also monitor any emails sent to me, including file attachments, for viruses or malicious software. Please be aware that you have a responsibility to ensure that any email you send me is within the bounds of the law.
4 - I keep an attendance register which records appointments for patients attending my clinic to keep a record of when you were treated for tax purposes and to secure potential evidence in the event of a criminal prosecution, civil litigation, insurance claim or complaint to my regulatory body, the British Acupuncture Council.
5 - I may use your date of birth to help identify patients with the same name to avoid mistakes being made as to safe and appropriate treatment, for identification purposes if referring a patient to another health practitioner, and for identification purposes if writing to a registered medical practitioner so that they correctly identify the patient.
6 - I use your presenting complaint and symptoms reported by you for the purposes of making a full traditional diagnosis, formulating treatment strategy and treatment planning.
7 - I use any relevant medical and family history you have told me for making a full traditional diagnosis, formulating treatment strategy and treatment planning.
8 - I use your GP’s name and address in the event that I need to contact your GP including in an emergency and because it is a mandatory requirement in the British Acupuncture Code of Professional Conduct.
9 - I use my clinical findings about your health and wellbeing for making a full traditional diagnosis, and formulating treatment strategy and treatment planning.
10 - I keep a record of and refer to that record of any treatment given and details of progress of your case, including reviews of treatment planning to enable me to: review the full traditional diagnosis, treatment strategy and planning; and to secure evidence in the event of criminal proceedings, civil litigation, an insurance claim or complaint.
11 - I record and use any information and advice that I have given, especially when referring patients to any other health professional, to help you to receive the most appropriate treatment and to secure evidence in the event of criminal proceedings, civil litigation, an insurance claim or complaint.
12 - I record any decisions made in conjunction with you to help you to receive the most appropriate treatment and to secure evidence in the event of criminal proceedings, civil litigation, an insurance claim or complaint.
13 - I keep accident records for any patients, visitors or staff who are involved in accidents at my clinic in accordance with UK Health and Safety legislation including the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) to comply with the law and to secure evidence in the event of criminal proceedings, civil litigation, an insurance claim or complaint.
14 - In the event of an adverse incident occurring to any of my patients I report the matter to the British Acupuncture Council and my insurance company to enable the insurance company to deal with any potential claims and to help the British Acupuncture Council to develop its safe practice guidelines, as well as providing research data and information for the BAcC’s insurers and other interested parties.
15 - Where relevant I maintain records of the patient’s consent to treatment, or the consent of their next-of-kin in order to be able to prove that the patient (and/or parent/guardian/next of kin) has given informed consent to treatment to secure evidence in the event of a civil claim, criminal prosecution, insurance claim or complaint.
Section 16 applies to those who complain about my services
16 - I aim to provide you with the best quality treatment that I can. This includes working with your feedback to each treatment to continuously adjust the treatment to your needs. In this way I aim for us to work well as a team always.
Should you ever feel the need to make a complaint I make up a file containing the details of the complaint. This normally contains the identity of the complainant and any other individuals involved in the complaint.
I will only use the personal information I collect to process the complaint and to check on the level of service I provide. I usually have to disclose the complainant’s identity to whoever the complaint is about. If a complainant doesn’t want information identifying him or her to be disclosed, I will try to respect that. However, it may not be possible to handle a complaint on an anonymous basis. I may need to provide personal information collected and processed in relation to complaints to the British Acupuncture Council or my insurance company.
I will keep personal information contained in complaint files in line with my retention policy. This means that information relating to a complaint will be retained for two years from closure. It will be retained in a secure environment and access to it will be restricted according to the ‘need to know’ principle.
Similarly, where enquiries are submitted to me I will only use the information supplied to me to deal with the enquiry and any subsequent issues and to check on the level of service I provide.
I store and transport my records electronically.
Sharing your personal data
Your personal data will be treated as strictly confidential, and will be shared:
• with named third parties with your explicit consent;
• with the relevant authority such as the police or a court, if necessary for compliance with a legal obligation to which I are subject e.g. a court order;
• with your doctor or the police if necessary to protect your or another person’s life;
• with the police or a local authority for the purpose of safeguarding a children or vulnerable adults; or
• with my regulatory body, the British Acupuncture Council, or my insurance company in the event of a complaint or insurance claim being brought against me; or
• my solicitor in the event of any investigation or legal proceedings being brought against me.
For further details about the situations when information about you might be shared please see the Information Commissioner’s Website at
How long do I keep your personal data?
I keep your personal data for no longer than reasonably necessary.
I keep patient records for a period of 7 years in accordance with the British Acupuncture Code of Professional Conduct
I keep your record up to date by monitoring your progress when we discuss your treatments and health.
I destroy any records kept in hard copy by shredding all such data when it is no longer required. I destroy any records kept electronically by permanently deleting such data when it is no longer required.
If I am ill such that I am unable to treat you, I will pass any data to another acupuncturist whom you have decided to be treated by. You will have to give me written permission before I can do this.
When I die, I will authorise my personal representative to transfer any data concerning you to another acupuncture whom you have decided to be treated by. If you do not give written permission for this within three months of my death, my personal representative will securely destroy my records concerning you.
At any time you may request that changes are made to your contact details.
Your rights and your personal data
Unless subject to an exemption under the GDPR, you have certain rights with respect to your personal data as set out below.
The right to request a copy of your personal data which I hold about you.
The right to request that I correct any personal data if it is found to be inaccurate or out of date.
The right to request your personal data is erased where it is no longer necessary for me to retain such data.
The right to withdraw your consent to the processing at any time. This right does not apply where I are processing information using a lawful purpose other than consent.
The right to request that I provide you with your personal data and where possible, to transmit that data directly to another data controller, (known as the right to data portability).
The right, where there is a dispute in relation to the accuracy or processing of your personal data, to request a restriction is placed on further processing.
The right to object to the processing of personal data, where applicable.
The right to be informed if your data is lost. I shall also inform the Information Commissioner’s Office in accordance with the time limits in the GDPR.
The right to lodge a complaint with the Information Commissioner’s Office.
For further details about these rights please see the Information Commissioner’s Website at
If I wish to use your personal data for a new purpose, not covered by this Privacy Notice, then I will provide you with a new notice explaining this new use prior to commencing the processing and setting out the relevant purposes and processing conditions. Where and whenever necessary, I will seek your prior consent to the new processing.
To exercise all relevant rights, queries of complaints please in the first instance contact me at or by a message to 07954 013 156.
You can contact the Information Commissioners Office on 0303 123 1113 or via email or at the Information Commissioner's Office, Wycliffe House, Water Lane, Wilmslow, Cheshire. SK9 5AF.