Strivesocial | Privacy Consent Form (Easy Read)

What is a consent form?

Your informed consent for sharing information will be sought and respected in all situations. You can tell us how you want us to use your information.

Your Name: ___________________

We may collect the following personal information: Participant details, identifiers, service details, medical information, financial information, and interaction records. 

We may collect recorded material such as audio/visual formats.

Please select yes or no to the following.

No, I do not want you to use any information about me.

Yes, you can use information about me for purposes authorised by me.

☐ I  understand that Strivesocial will collect, store and use the information collected to provide services to me.

☐ I give permission for photos to be published on Strivesocial’s website or social media. 

☐ I give permission for use of my data for internal training and operational purposes.

☐ I give permission to participate in NDIS audits and other activities. 

☐ I consent to my information being provided to other service providers.

☐ I consent to my information being provided to authorities such as health professionals, medical specialists etc. Specifically, you can provide my information to: _____________________ 

        (please specify)

If you want to change your consent to any of the above, you can tell us.

Sign your name ___________________________

Date: ___/___/___

You can get someone to sign the form for you.

Representative’s Name: ______________________

Representative’s Signature: ______________________

What happens with this form?

We will keep this form private and in a safe place.