Background Details

Clinical Concerns

Educational Institution Details

Collection Statement

Allied Health Services

SASHC is required to collect and record personal information about you and your child in order to provide quality allied health services. This may include assessing, diagnosing and providing therapy. This information is relevant to your child’s situation, such as your child’s name, contact information, medical history and other relevant information as part of providing services to you.  This collection of personal information will be a necessary part of the assessment and/or treatment that is conducted.

Purpose of Collecting and Holding Information

All personal information gathered as part of your child’s assessment and treatment, is kept securely.  In the interest of your child’s privacy this information is only used by your child’s therapist/s and authorised SASHC staff . Your personal information is retained for record keeping purposes and enables your child’s therapist to provide a relevant and informed service to you/your child.  A more detailed description is provided in the SASHC “Privacy Policy”.   This policy is available to you on request.

Access to client information

At any stage you are entitled to access your child’s personal information kept on file, subject to exceptions in the relevant legislation.  SASHC will discuss with you your different possible forms of access.

Disclosure of personal information

All personal information gathered by SASHC during the provision of allied health services will remain confidential, however, please note that by signing and acknowledging this document, you accept that information will be shared with other allied health professionals involved in your child’s care.

Please notify us if you do not wish us to disclose this information or if a child protection/court order is in place.


have read, understood and agree to the above conditions, and as the authorised person, agree to the provision of services by SASHC.

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