•That Dr Sana Barada, Pharmacologist specializing
in addiction studies, will be offering an educational tutoring service
regarding the personal well-being conditions of the undersigned based on their
•To this end educational tools may be used for the
prevention, training and tutoring in the behavioral sector;
•The main service tools will be interviews and
teaching sessions which would be done via phone calls, online or in person
•The fee for the service offered will be agreed
between both parties. The undersigned has been
informed clearly that the amount paid for the service received cannot be
reimbursed. The undersigned has read and agreed to not ask for a refund, even
partially, for the cost of the service already performed.
•If I am unable to come to an appointment, I will
give 24-hour notice; in the event of not giving notice I will still be obliged
to pay the amount agreed upon for the professional service if I did not cancel within the 24 hours prior.
•I am free to withdraw from the service at any
time. In order to ensure the best outcome of the same I will inform Dr Sana
Barada of my intention to withdraw and make myself available, at my own
discretion, to attend a final meeting for the purpose of summarizing the work
carried out until that time and I promise to pay the fee
for the services/hours received up to that point.
•The specialist is obliged to maintain a serious
and professional attitude in carrying out the service.
•There is an agreement between the undersigned
and Dr Barada that the tailored educational program will be displayed in a very
clear manner in the session following the signing of
the following consent.
•The undersigned exempts Dr Barada from any
liability related to how they make use of the information received, considering
that the given information is purely scientific and does not constitute neither
a therapy nor a medical consultation.
•Any dispute arising out of the interpretation or
implementation of this agreement and its derivative shall be exclusively
subject to Italian law and liability accepted under the jurisdiction of the
•The undersigned has been informed that their
personal information is protected by the regulations of GDPR 2016/679 (check
the attached document). The undersigned has given their approval to Dr. Barada
to see and process their personal information related to the agreed program’s
In the case of a minor: informed of all this, we (mother and father of
the minor) accept that our son/daughter benefits from the service agreed with
Dr. Sana Barada
Hereby I/we declare to have been informed of the following points
relating to the informed consent:
1.The service offered concerns
2. The service
entails addiction-related prevention, training and tutoring activities.
3.In order to achieve the objective,
the following instruments will prevalently be implemented:
Interviews and educational sessions.
I/we have been informed about the following points relating to the processing
of personal data pursuant to EU Regulation 2016/679:
1.The EU Regulation 2016/679
(hereinafter, the GDPR- General Data
Protection Regulation) provides for and reinforces the protection and processing of personal data in
the light of the principles of correctness, lawfulness, transparency,
protection of privacy and rights of the data subject regarding their data.
2. Dr. Sana Barada is the Data Controller of the
processing of the following data collected for the performance of the
assignment, subject of this agreement:
a. personal data, contact information and payment
details - information relating to the name, telephone number, EPO and PEC
address, as well as information regarding the payment of the fee for the assignment
(e.g. credit/debit card number), etc.
b. Your personal data may be shared
with natural persons authorised by the Data Controller subject to the signing
of a confidentiality agreement with medical specialists, third parties,
entities or authorities pursuant to the legal provisions.
for the processing: performance of
contractual/pre-contractual obligations. The granting of consent is compulsory.
3. Your personal data will be subjected
to printed, electronic and/or automated processingmethods, therefore in both manual
and computerised node. In any case, all appropriate measures will be adopted in
order to protect their confidentiality, in observance of the regulations in
force and professional secrecy.
4. Appropriate security measures will be taken to guarantee the protection,
security, integrity and accessibility of your personal data.
5. Your personal data will only be
stored for the time strictly necessaryfor achieving the purposes for which they have been collected or for any other connected
6. Personal data that is no longer
necessary, or for which there is no legal requirement for its relative storage,
will be rendered irreversibly anonymous
or destroyed in a secure manner.
7. The storage times, in relation to
the different purposes listed above, will be as follows:
a. Personal data, contact and payment
details will only be stored for the time
strictly necessary for fulfilling the contractual/accounting obligations and
subsequently for a period of 10 years;
b. Data relating to health conditions will only be stored for the time
strictly necessary for performing the assignment and achievement of the
purposes of the same, and in any case, for a minimum period of 5 years (art. 17 of
the Code of Ethics of Italian Psychologists).
8. The list of data processors and any third-party subjects to whom or to
which the data are communicated can be viewed on request.
9. In the event of the continuation of
certain conditions in relation to the specificities connected to the performance
of the assignment, it will be possible for the data subject to exercise
referred to in articles 15 to 22 of the GDPR (such as the right to access
to personal data, the right to rectification, erasure, and restriction of the
processing, the right to receive the personal data concerning him or her in a
structured, commonly used and machine-readable format, as well as the right to
transmit said data to another data controller).
examined and understood everything indicated above on my/our own behalf.
In case of
a minor, having examined and
understood all of the above in exercising parental responsibility on the minor,
Having received the relative
professional information and all appropriate data regarding the purposes and
methods of the same, I/we hereby give my/our own free consent.
Having received the relative
information regarding the processing of personal data and in relation to
everything indicated above regarding the processing and communication of my/our
own personal data for the purposes indicated in this statement, I/WE GIVE MY/OUR CONSENT.