Consent Form / Explicit Consent Text
1. Information and Free Will Statement: I confirm that I have read and understood the KVKK Information Notice prepared by ÖZEL SEÇİL SÖNMEZ AĞIZ VE DİŞ SAĞLIĞI POLİKLİNİĞİ LTD. ŞTİ. and that my explicit consent, where required, is given freely, for a specific subject and independently from the information notice. I understand that my explicit consent is not presented as a precondition for receiving healthcare services.
2. Processing and Transfer of Personal Data: For processing activities that are not covered by legal exceptions and that require explicit consent, I give my explicit consent for my personal data to be processed and transferred only for specific, explicit and legitimate purposes, in a way that is relevant, limited and proportionate to those purposes.
3. Special Categories of Data and Special Uses: I understand that my special categories of personal data, including health data, may be processed not for advertising, promotion or demand generation but only for the specific purposes stated in the information notice or separately notified to me. I acknowledge that separate information and consent may be required for visual recording, publication or similar uses.
4. External Contact Channels: If I choose to use the website’s WhatsApp link (https://wa.me/905519771313?text=Merhaba%20%C3%96zel%20Se%C3%A7il%20S%C3%B6nmez%20A%C4%9F%C4%B1z%20ve%20Di%C5%9F%20Sa%C4%9Fl%C4%B1%C4%9F%C4%B1%20Poliklini%C4%9Fi%2C%20randevu%20ve%20tedavi%20bilgisi%20almak%20istiyorum.), Instagram profile (https://www.instagram.com/secilsonmezdis/), Google Maps direction link (https://maps.google.com/?q=Mehmet%20Ali%20Alt%C4%B1n%20Cad.%20No%3A85%20Akdere%20Mamak%20Ankara) or the mailto email-draft flows opened through mailto:Dtsecilsonmez@gmail.com and mailto:sonmezsecil17@gmail.com, I understand that the contact form does not send the message through the website, that the request is prepared as a draft in the email application or provider that I choose, and that if I complete the send action the relevant content may also be processed by that third party under its own terms.
5. Communication Activities: I understand that any consent I provide for optional communication activities is assessed separately for commercial electronic communications other than appointment reminders and that I may withdraw that consent at any time.
6. Withdrawal of Consent: I have been informed that I may withdraw my explicit consent in whole or in part at any time, free of charge and through an easy method, and that the withdrawal will not affect processing that was lawfully carried out before the withdrawal date.
Data Subject Statement: I have read and understood the matters above. For processing activities that require explicit consent, I provide my approval within the framework described in this text and through my own free will. On the website, consent boxes must be presented without pre-ticking and must require an active user action.
Full Name: Date: May 1, 2026 Signature / Digital Consent Log: