Client Consent Form

This form must be completed by the Participant/Client if they have the ability to make their own decisions. If they do not have capacity, this form must be completed by the Guardian, NDIS Nominee, Formal decision maker or Informal decision maker.

This form is used to give permission (consent) for Rehability Australia ABN: 62 132 347 990 to obtain and/or share information in relation to the delivery of its services with you.

Our practice will work closely with other agencies to coordinate the best support for you. This means your informed consent for the sharing of information will be sought and respected in all situations unless:

we are obliged by law to disclose your information regardless of consent or otherwise;
it is unreasonable or impracticable to gain consent or consent has been refused; and
the disclosure is reasonably necessary to prevent or lessen a serious threat to the life, health or safety of a person or group of people.

Details of Participant/Client this consent relates to:

First Name *

Surname *

Address *

Street address *

City *

State *

Postcode *

Other

A 'communication circle' is a system of communication set up as an email group to notify key stakeholders of specific information, events and updates to ensure open and transparent communication with all parties. All clients are asked to consent to who they would like to be included in this communication circle.

Other

The person completing this form confirms the following:

I acknowledge that I have been provided information regarding the 'Privacy Policy' contained within the Rehability Australia Welcome Booklet (click on link to access the Welcome Booklet).

NDIS Welcome Booklet

Non-NDIS Welcome Booklet

*

I acknowledge that I am aware of my right to access my personal information. *

I understand and agree that my personal information may be collected and why, including recorded material in audio and/or visual format. *

I understand that my provider must comply with relevant privacy laws and I will contact the organisation immediately if I feel that these laws have been breached. *

I understand why certain information about me may need to be provided to other service providers in order to coordinate the best support for me. *

I confirm that my consent will continue for the duration of my time working with Rehability Australia, and my consent can be withdrawn at any time. *

Yes

Name of Person completing this consent form: *

Relationship to Client *

Signature *

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Date *

Version Control

V 1.2

23/10/23

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