As Klinista, we may need to learn your personal information and health data in order to carry out the services we will provide to you, and to record and store them within the limits required by the service to be provided.

Your health data, which we have to record in order to provide you with health services, is considered as special personal data by law. In this context, the Personal Data Protection Law No. 6698 in
paragraph 2 of Article 6 located in ‘special quality of personal data is prohibited without the express consent of the relevant processing.’ Since personal health data can only be recorded with the explicit written consent of the person, except for the special conditions specified in the law, itis obligatory to obtain this consent from you.


  1. This consent is obtained from the personal data you provide to us verbally, in writing, visually, or electronically during our examination, as well as the data you transmit to us via the internet and mobile applications or electronically, or obtained in our practice (analysis result, prescription, camera recording, video, photograph, etc.). covers your personal data.
  2. In this sense, your name, surname, TR identity number, (if you are not a Turkish citizen, your passport number or temporary TC identity number), place and date of birth, marital status, gender, in particular the personal health data required for the performance of the services we will provide to you and obtained for this purpose. Identity data such as your information and various identity documents, your contact data such as your address, telephone number, e-mail address, your financial data such as your bank account number, IBAN number, your medical history in your clinical file, information showing your disease history, your examination data, data regarding the transactions applied to you, Your health and sexual life data obtained during the execution of medical diagnosis, treatment and care services such as your prescription information, photos, all kinds of images, audio/camera recordings, laboratory and imaging results, test results, your data on private health insurance and Social Security Your institution data etc. is considered personal data.
  • This personal data 6698 No. Personal Data Protection Law and the relevant legislation will be saved only to the extent required by the health service will be available to you and ‘ … to carry out the recorded aim to exceed the time required’ in our system / our archive will be stored. In this context, your processed data will be protected as professional secret, confidentiality will be ensured and will not be shared by third parties/institutions/organizations.
  1. However, in cases where the privacy of personal medical records must be restricted for the protection of public health, such as the obligation to notify the competent authorities of infectious diseases regulated in Article 58 of the General Sanitary Law No. 1593, or in cases of legal obligation such as the obligation to report a crime, only limited to the purpose and in moderation. We remind you that it may be necessary to notify the competent authorities in a way that may be shared with another physician for the purpose of consultation (opinion exchange) about your health condition.
  2. Requests from public institutions, judicial authorities and other official authorities for the transmission of your data to them, the purpose of the request, whether the requested data overlaps with the purpose to be achieved, whether it can be put forward in a concrete way, the only way to achieve the stated purpose is the necessity of transmitting your data without anonymization, data transmission requests that do not meet all of these elements will not be fulfilled.
  3. Regarding your data recorded by us, in particular, in accordance with the Convention on the Protection of Individuals Against Automatic Processing of Personal Data (Convention of the Council of Europe No. 108), Article 8 of the European Convention on Human Rights, Article 20 of the Constitution, Law No. 6698 on the Protection of Personal Data:
  • To learn whether your personal data is processed and the scope of your
    processed data,
  • If your personal data has been processed, obtaining information about it,
    accessing these data and taking samples from them,
  • To learn the purpose of processing your personal data and whether they are used
    in accordance with its purpose, to learn whether it has been transferred to a third
    person or institution in the country or abroad, to request that the changes in your
    personal data be notified to the persons or institutions with whom the data is
  • Requesting correction of your personal data in case of incomplete or incorrect
    processing, (Been informed that this right can be exercised in person or by
    applying in writing to our practice address Suadiye Mah. Bağdat Cad. No:411/5 Kadıköy / İstanbul / Turkey)
  • You have the right to request that some of your data be hidden, deleted or


I have read and understood the Personal Data Disclosure and Consent Text prepared by Klinista Sağlık (Clinista as a Brand Name) , and that I have been given verbal information on the subject,

I have been informed about the purposes of processing, collection methods and legal reasons for my personal data, my rights to protect my personal data, the mandatory conditions to which my data can be transferred, my data security and application rights, which are detailed in the Personal Data
Disclosure and Consent text, All of my personal data, including my health data, within the framework of the above principles, to Klinista and its employees to be recorded, stored, shared in the mandatory cases listed, Also, Klinista by means of the mobile tools I have mentioned below, via the internet or by mail to my
address, etc. reaching the


*As per the Patient Rights Regulation; 1 copy of the form will be given to you. If the form is not given to you, please notify the person receiving the consent.

You can print this document and sign back

Patient Name – Surname ……………………….  




Signature :………… Date: ……./……./……… Time: …..



If the patient is younger than 18 years old or unconscious:


Patient Relative Name – Surname : ………………………………………..

Signature: ………… Date: ……./……./……… Time: …..

Degree of Proximity: …………………………..


Write “I understood what I read” in your own handwriting :…………………………………………………………………..



TRANSLATOR IF AVAILABLE (If the patient has a Language / Communication Problem)

In my opinion, the information I translated was understood by the patient/patient relative.

Name of Translator : ………………………….…….


Signature: ………… Date: …../……./……… Time: ……