Privacy Consent to Collaborate

Privacy Consent to Share Information and/or Collaborate

To enable Transforming Kids to share information with other providers, schools or medial professionals we need you to consent to the sharing of information.

This form is super important to enable Transforming Kids to adhere to Australian Privacy Law, so please read it carefully to understand what you are providing us with permission to do and any associated costs of doing as you wish.

I give Transforming Kids permission to:

Share reportsShare support plansDiscuss Client specifics and servicesTo attend a scheduled meeting

Client Details

Full Name

Date of Birth

Provider Details

Please outline the contact details of the people or person you wish for the above stated actions to occur with.

First name *

Last name *

Organisation *

Email address

Phone Number

Provider 2 Details

Provider 2 Full Name

Organisation *

Provider 2 Email address

Provider 2 Phone Number

Meeting Details- Complete if appropriate

Date/Time of Meeting if Known

Questions

In case you have questions before completing this consent form, you may get in touch with:
Email: admin@tteam.com.au
Phone: 02 9621 2504

In case you have any accounting/ funding specific questions, you can get in touch with our accounting team via the below:

Email: accounting@tteam.com.au

Phone: 02 9621 2504

Costs Associated with Collaborating

If you have requested clinician collaboration such as attendance at meetings, phone calls, Teams Meetings ect. You will incur added charges associated with the time taken to complete the requested collaborations. You will also receive a completed Note outline of the collaboration for your records.

If you wish to discuss the collaboration post collaboration with the clinician. Please contact Admin who can book a time for you with the clinician.

If you would like to specify how long or an expectation of how long you would like to budget for the collaboration. Please state your expectations below for example, a quick 10 minute email or your expectation. *

Any other information

If so, please specify what this information is below:

Your declaration

Please note: Clients’ aged 18 and over have other options instead of signing this consent form.

If you are unable to sign in Part D, you may provide verbal consent, or
You can direct someone aged 18 and over to sign (your ‘delegate’) in the presence of a witness.

If you direct a delegate to sign on your behalf, your delegate and witness needs to complete Part E. Otherwise, please sign, below.

By signing this consent form (please mark each box below):

I understand the sharing and collaborations as outlined will be actioned as outlined

*

I understand I will be requested to pay for the time and expertise of the clinician in completion of any collaboration

*

I understand I can withdraw or change my consent to share information and/or my permission for a third party to act on my behalf at any time.

*

Signature

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Name *

Date *

If you are not the participant, please mark the relevant box below to indicate your relationship to the participant

Child representativeLegally Appointed Decision Maker

Your delegate's declaration

Please note: This section is only to be completed if you, the participant, is unable to sign this form in Part D. Instead, your chosen ’delegate’ must be aged 18 and over and can sign in the presence of a witness.

Signature of participant’s delegate

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Name of participant’s delegate

Signature of witness

Draw signature|Type signatureClear

Name of witness *

Date

Witness certification (please mark each box below):

I certify this document was signed by the delegate in the presence of the person providing consentI certify that consent was provided freely and voluntarily; andI certify that the person providing consent has decision making capacity in relation to the provision of consent provided.

I am Human *

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