Consent to share your information - NDIS Participant

Participant Details

First Name(Required)

Last Name(Required)

Date of birth

NDIS number

Address

Street Address Address Line 2 City State Post Code

Consent type (check all that apply)(Required)

Delivery of SDA tenancy and property services

Sharing of information with support providers and stakeholders

NDIS

Other

Other consent type

Participant consent(Required)

I understand the purpose of this form and consent to Link Wentworth Housing providing services as outlined.

I understand that consent is voluntary and can be withdrawn at any time by providing written notice.

I understand that Link Wentworth Housing will maintain confidentiality, in accordance with the Privacy Act 1988 (Cth) and the NDIS Code of Conduct.

The participant is unable to communicate verbally or in writing. In this case, consent is provided by the participant’s authorised representative or legal guardian (go to Section B).

Does the participant have a formally appointed legal guardian, plan nominee, or enduring power of attorney?

Yes

Is the participant being assisted by a family member, advocate, or support person?

Yes

Legal Guardian / Authorised Representative

First name(Required)

Last name(Required)

Relationship to participant(Required)

e.g. legal guardian, plan nominee, power of attorney, public trustee.

Organisation

Contact number(Required)

Email(Required)

Signature(Required)

Unauthorised Guardian / Informal Representative

First name(Required)

Last name(Required)

Relationship to participant(Required)

e.g. parent, sibling, carer, support worker, advocate

Contact number(Required)

Email(Required)

Signature(Required)

Forms

Consent to share your information – NDIS Participant

Participant Details

Legal Guardian / Authorised Representative

Unauthorised Guardian / Informal Representative

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