NDIS Cleaning Intake – Yahweh PC Portal

NDIS - CONSENT TO SHARE AND INTAKE FORM

IMPORTANT COMPLIANCE NOTE
This form ensures services are delivered in line with NDIS requirements.
NDIS funds disability-related supports ONLY — not general services.

1.NDIS - CONSENT TO SHARE INFORMATION

Purpose: This form records your consent for Yahweh Property Care to collect, use and share information needed to assess your needs, provide services, coordinate supports, manage safety and meet NDIS and legal requirements.

Participant name:

Representative / guardian name:

NDIS number:

Date of birth:

Relationship:

Phone / email:

Decision-making status:

Participant makes own decisions

Under 18

Guardian / nominee / other authorised decision-maker

2. CONSENT TO COLLECT, USE AND SHARE INFORMATION:

I consent to Yahweh Property Care collecting and using my personal and sensitive information, including relevant NDIS and health information, to provide and manage my services. I also consent to relevant information being shared, when reasonably necessary, with people or organisations involved in my supports, such as the NDIA/NDIS, my support coordinator, plan manager, health professionals, service providers, government agencies and my authorised representative. My information will be handled in line with privacy and NDIS requirements. I understand that I may change or withdraw this consent at any time, except where disclosure is required or authorised by law or necessary to address a serious safety concern.

3. NOMINATED PERSON (OPTIONAL):

Name:

Relationship:

Phone / email:

4. OPTIONAL TESTIMONIAL, PHOTO AND VIDEO CONSENT

YES, I consent to Yahweh Property Care using my testimonial/feedback and photos/videos for its website, social media and marketing.

NO, I do not consent.

5. DECLARATION AND SIGNATURES:

I confirm that I have read and understood this form, had the opportunity to ask questions, and give consent as selected above.

Name:

Date

Signature

Clear

If you are human, leave this field blank.