Template: This is a customizable template. Fill in the fields in [brackets] with your practice information before distributing to patients.

Patient Information and Consent

Use of AI-Powered Assistant for Appointment Scheduling

Patient Information

First Name

Last Name

Date of Birth

Patient ID

About Our AI Assistant

Our practice uses an AI-powered voice assistant to help you book appointments. This assistant, provided by AIAgens, can receive calls to schedule, modify, or cancel appointments.

                i Important Information
                The assistant identifies itself as AI at the start of each conversation
Your voice is NOT recorded - voice data is processed in real-time and immediately discarded
Only appointment data is stored (name, date, time, appointment type)
You can request to speak with a human at any time

            

Data Processing

The following data is processed:

Contact data: Name, phone number
Appointment data: Date, time, appointment type
Technical data: Call duration, timestamps

Data is processed in accordance with Swiss FADP and EU GDPR.

Your Rights

✓ Access to your data

✓ Correction of data

✓ Deletion of your data

✓ Withdrawal of consent

Consent

Withdrawal

You may withdraw your consent at any time by contacting us. Withdrawal does not affect the lawfulness of processing carried out before the withdrawal.

Patient

Signature

Place, Date:

Legal Representative
(if applicable)

Signature

Place, Date:

For questions, please contact our practice or privacy@[your-practice].ch