Consent to share information

This form grants Aries Care Pty Ltd to share the information provided in your application with Aries Care Pty Ltd staff, and other service providers who may contribute to your care and support.

Are you filling this form on behalf of someone?*

Yes

What is your name*

First

Last

What is your relationship to the person?*

Email address*

Contact number

Participant name*

First

Last

Date of Birth*

Email address*

Contact number

I have obtained consent from {1_13} to discuss, share and to obtain services on their behalf.

I understand that I have the right to restrict what information may be shared and with whom.

I agree that the information provided in my application may be shared with Aries Care staff, and other service providers who may contribute to my care and support. I understand that other agencies may be asked for information about me. In order for Aries Care to carry out a comprehensive intake process.

Consent to access the following:*

OT Report

Behaviour Support Plan

Allied Health Details

I understand that this information will be used for the purpose of providing the most appropriate services or supports to me.

I also understand that agencies may use anonymised information for statistical purposes and that the law may allow in some circumstances for other agencies to be provided with information about me.

I understand that I may withdraw my consent to share information at any time and this may result in a review of the services being available.

In order to alter your consent, please contact the staff member you have most contact with.

I understand the terms above:*

Yes

This field should be left blank

Consent to share form

Consent to share information