NDIS | Disability Service Providers | Enhanced Lifestyles

SC - QF126 Information Collection and Sharing Consent Form


Enhanced Lifestyles needs to collect, use, store and share personal and sensitive information regarding our customers to facilitate the provision of services and fulfil our role and requirements as a disability services provider. This includes:

  • Collection of information for the purpose of providing disability supports;
  • The disclosure of information to relevant funding bodies, and;
  • The disclosure of information required under law to State and Federal Government agencies.

The details on what information we collect, what purposes it is used for, and circumstances under which we may disclose information, as well as your rights regarding your personal and sensitive information are described in Q108 – Privacy and Information Sharing Policy.

Customer consent to collect information:

I agree to allow Enhanced Lifestyles to collect and use the personal and sensitive information required for the provision of disability support services as described in Q108 – Privacy and Information Sharing Policy.

Customer consent to share information

I agree to my personal and sensitive information being shared with the following people/organisations:

I do NOT agree to my personal and sensitive information being shared with the following people/organisations:

Client Signature


Customer/Client Name

Date:

NDIA Number:

Review of Consent
Consent should be reviewed on a regular basis as agreed with the Customer/Client. If there are any changes to this document a new form should be completed to reflect the current wishes of the Customer/Client (or, if the Customer/Client is incapable of giving consent, the review may be made by Enhanced Lifestyles and Lifestyle Assistance and Accommodation Service and/or the Customer/Client Representative should they feel it is necessary and in the best interest of the Customer/Client to do so).

Witness Name:

Witness Email:

Leave this empty:

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Signature Certificate
Document name: SC - QF126 Information Collection and Sharing Consent Form
lock iconUnique Document ID: 6d0aba7374a6ec3178fe4222572eea66f30be304
Timestamp Audit
December 16, 2020 3:28 pm ACDTSC - QF126 Information Collection and Sharing Consent Form Uploaded by Enhanced Lifestyles - enhanced.website@gmail.com IP 125.168.64.82
December 16, 2020 3:48 pm ACDTSupport Coordinator - scforms@enhancedlifestyles.com.au added by Enhanced Lifestyles - enhanced.website@gmail.com as a CC'd Recipient Ip: 125.168.64.82
February 10, 2021 3:35 pm ACDTSupport Coordinator - scforms@enhancedlifestyles.com.au added by Enhanced Lifestyles - enhanced.website@gmail.com as a CC'd Recipient Ip: 125.168.64.82
June 16, 2021 5:26 pm ACDTSupport Coordinator - scforms@enhancedlifestyles.com.au added by Enhanced Lifestyles - enhanced.website@gmail.com as a CC'd Recipient Ip: 125.168.64.82
July 22, 2021 3:49 pm ACDTSupport Coordinator - scforms@enhancedlifestyles.com.au added by Enhanced Lifestyles - enhanced.website@gmail.com as a CC'd Recipient Ip: 125.168.64.82
July 22, 2021 4:17 pm ACDTSupport Coordinator - scforms@enhancedlifestyles.com.au added by Enhanced Lifestyles - enhanced.website@gmail.com as a CC'd Recipient Ip: 125.168.64.82