Consent Form — My Life My Care

My Life My Care Consent Form

At My Life My Care, our foremost commitment is to safeguard the confidentiality and protection of our clients' personal information. We fully recognise our responsibilities in accordance with The Australian Privacy Principles outlined in The Australian Privacy Act 1988 (with amendments in 2014).

Full Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

Email

Address

Phone Number

(###)

###

####

NDIS number (If applicable - write n/a if not)

Record for Consent (please tick the boxes you consent to My Life My Care providing for you)

Written Consumer Consent

Verbal Consumer Consent

Dignity of Risk

Audio/Visual

Social media access

Other

Please describe if you selected 'other'

Date

MM

DD

YYYY

How did you hear about My Life My Care?

Text

If other, where did you hear about us from?

My Life My Care Consent Form

Your Life, Your Plan, Our Goal.