Client Consent Form

Client Details

Full Name *Date of Birth *

Address *

Phone *Email

Consent Declarations

I consent to ASAH Care collecting and storing my personal and health information for the purpose of coordinating and delivering care services.I consent to ASAH Care sharing my information with relevant health professionals, My Aged Care, and government bodies as required.I understand I have the right to access my personal information and request corrections at any time.I consent to ASAH Care taking photos or videos during care visits for quality assurance purposes (optional).I have read and understood ASAH Care's Privacy Policy.

Signature

Type your full name as a digital signature *Date *I am signing on behalf of the client