Consent form

Your information, your say

Two short steps: what we do with your information in plain English, then your choices and your signature. You can change your mind about any of it, any time.

2 short steps Every choice can be changed later

In short: we collect your personal information so we can

plan and provide your supports, and keep improving them
report to the NDIS and other funding bodies on how funding is used
respond to your feedback and questions

We keep it confidential, and we don't use it for anything else without your say-so - the full detail is below.

Read the full privacy statement

Our collection, holding, use and disclosure of your personal information is protected by the Privacy Amendment (Enhancing Privacy Protection) Act 2012 (Cth). Personal information is anything that identifies you or could identify you, including information about your health.

We're required to release de-identified information about service users (never your full name or address) to the Disability Services Commission and the Australian Institute of Health and Welfare, so statistics about disability services can be compiled. This is used for statistics only and never affects your entitlements or access to services. You have the right to access your own files and to correct information held about you.

We won't disclose or use information about you for any secondary purpose unless:

you've consented, or you'd reasonably expect it because it's directly related to why we collected it
it's required or authorised by Australian law or a court or tribunal order
we reasonably believe it's necessary to lessen or prevent a serious threat to someone's life, health or safety, or to public health and safety
we have reason to suspect unlawful activity or serious misconduct relating to our organisation's functions
we reasonably believe it's necessary to help locate a person reported missing

If your circumstances change, please tell us as soon as you can.

Photos, videos and staying in touch (all optional) Tick only what you're happy with. Every one of these can be switched off later with a phone call.

Yes - photos and videos of me may be used for therapeutic purposes Yes - photos and videos of me may be used for marketing Yes - send me the newsletter Yes - contact me about service-related opportunities

Participant's full name

Are you signing on the participant's behalf?

No - I'm the participant Yes

If the participant can't give informed consent and has no legal guardian, a parent, family member or someone with a close personal relationship may sign instead - just tell us who you are.

Your full name

Relationship to the participant

I agree to Beyond Disability Support collecting, storing, using and disclosing personal and sensitive information, including health records, to provide services - as described in the privacy statement.

Sign your way

Draw your signature, or type your name - both count equally as your signature.

Draw it Type my name

Sign here with your finger, mouse or stylus

Type your full name

Your typed name will appear here as your signature.

I intend this to be my signature on this form, and I understand it counts the same as signing on paper.

Check your answers

Nothing is sent yet - change anything you like first.

Your consent is dated and kept with your file. Change or withdraw any part of it, any time, with a phone call.

Your consent is recorded

Thank you. Two things worth remembering:

You can change or withdraw any part of this whenever you like - one phone call does it
If your circumstances change, just let us know