CLIENT CONSENT FORM

HAPPY ORANGE SUPPORT SERVICES will work closely with you [the client] and any other family, medical or approved authorities to coordinate the best support for you. This means your informed consent for the sharing of information will be sought and respected in all situations unless:

we are obliged by law to disclose your information regardless of consent or otherwise;
it is unreasonable or impracticable to gain consent or consent has been refused; and
the disclosure is reasonably necessary to prevent or lessen a serious threat to the life, health or safety of a person or group of people.

First Name

Last Name

Date of Birth

Pleae read carefully and tick all the boxes below

I hereby acknowledge that I am aware of my right to access my personal information

I hereby acknowledge that I am aware of my right to withdraw my consent at any time.

I understand that I must comply with relevant privacy laws and I will contact Happy Orange Support Services immediately if I feel that these laws have been breached.

I understand why certain information about me may need to be provided to other service providers in order to coordinate the best support for me

Consenting Clients Name:

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

happy orange SUPPORT SERVICES

CLIENT CONSENT FORM

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SUPPORT SERVICES