Third Party Privacy Form

Third Party Consent Form

Cosy Coordination

We will work closely with other providers and organisations to ensure you receive the best possible support. Your informed consent will always be sought and respected before sharing any information, except in the following circumstances:

We are legally required to disclose information, regardless of consent.
It is unreasonable or impracticable to obtain consent, or consent has been refused.
Disclosure is reasonably necessary to prevent or reduce a serious threat to the life, health, or safety of an individual or group.

Participant First Name *

Participant Surname *

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 my provider must comply with relevant privacy laws and I will contact the organisation 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 *

Full Name of person signing this form *

Relationship to Participant (if applicable)

Signature *

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Date *