Telehealth Consent Form

 

Consent form for collection and disclosure of information

Client Name*
DD slash MM slash YYYY
By signing this consent form, you are indicating that you understand and agree to Arthritis NSW:
(tick only that you agree to)
By signing this consent form you are indicating that you understand that:
Client Name*
Client Consent*
Guardian Name
Guardian Consent

Consent form for teleconsult, collection and disclosure of photos and videos

Client Name*
DD slash MM slash YYYY

Clinician’s often take photographs of their clients or client’s environment as a way of analysing movement, positioning or safety hazards, sometimes to track progression or recovery. With consent, we also like to at times share client’s achievements on our website or social media for marketing purposes and to give others a sense of what we can do to help. Due to the COVID-19 pandemic, it is now common practice to engage in teleconsult/teletherapy sessions.

By signing this consent form, you are indicating that you understand and agree to Arthritis NSW:
(tick only that you agree to)
By signing this consent form you are indicating that you understand that:
Client Name*
Client Consent*
Guardian Name
Guardian Consent