Before proceeding, please note that Unique requests a minimum of 3hrs for in-home supports and 4hrs for Community access (including meet and greet). If you require less hours, please discuss with your Support Coordinator or LAC.

Where possible, please attach the following documents to go with your referral form to better understand your needs and requirements.

Purpose of this Consent Form

Unique Support Services will need to collect and hold Personal Information about you. Sometimes, we may need to use and share your Personal Information with other workers or organisations. This may include other Service Providers or government or non-government agencies.

Unique Support will collect Personal Information from you that we use to assess your support needs. This is so that we can make sure you get the right supports. 

Unique Support may need to collect Personal Information about you so that we can meet the conditions of the National Disability Insurance Scheme (NDIS). Unique Support may also be required by law to collect Personal Information about you. 

Unique Support will respect and protect your privacy and dignity when using your Personal Information. Unique Support will follow the National Disability Insurance Scheme Act 2013 and the Australian Privacy Principles (APPs), which are in the Privacy Act 1988 (Cth), and which describe how we are required by law to collect, hold, use and disclose your personal information.

What is Personal Information?

Personal Information is information about you. It will range from your name and contact details to sensitive information such as your health information. This includes information about your NDIS plan and assessments and supporting documents about your health, safety, and wellbeing, such as medical records. It may also include other sensitive information about you like your race or ethnic origin or criminal record.

We will only use your Personal Information for the reason you gave it to us or to support activities in delivering a service to you or for internal business functions, such as assessing risk. 

We may need to provide Service Providers with your Personal Information. This may include, but is not limited to:

• Hospitals

• health care providers

• pharmacies

• legal providers

• government bodies and agencies including the NDIS Quality and Safeguards Commission

• Medicare

• family and social support providers

• housing providers

• educational providers

• and public transport organisations. 

We may also need to disclose your information to organisations who assist with our business functions, such as IT providers.

Unique Support will need to access your Personal Information on the NDIS Portal. This is so that we can support you. You do not have to supply your NDIS plan to Unique Support. If you do not provide Unique Support with a copy of your plan or some or all of your Personal Information, Unique Support may not be able to provide you with all of the services you request.

There may be times when Unique Support will ask you for your verbal consent to share Personal Information. This may be so that we can quickly refer you to services or supports. 

There may also be times when we need to use your Personal Information or provide it to other parties without your consent, for example, if there is a serious threat to someone’s life, health, or safety, or if required or authorised by law.

Unique Support will safely store your Personal Information in our Client Records system.

You can ask Unique Support for details of the Personal Information we hold about you and ask us to correct your Personal Information if it is not correct.

Acknowledgment 

Please read the following acknowledgements. If you are unable to read them, an Unique Support staff member will read them to you. 

If you are providing written consent, please complete your details below and sign. 

If the partcipant is under the legal age of 18 and you are there legal gaurdian or authorised decision maker providing consent on their behalf, please complete your details below and sign.

If you are not able to sign and/or are giving verbal consent, these acknowledgments still apply. In this case, an Unique Support staff member will sign this form after explaining them to you. 

You acknowledge that:

• You have read and understood this form OR an Unique Support staff member has explained this form to you, and you understand what has been said. 

• You approve Unqiue Support to collect, use, share, and store your Personal Information in the ways explained in this form.

• You can withdraw your consent at any time. 

• If you withdraw your consent, Unique Support may not be able to provide you with some or all the services you request; and

• The details provided in this form are true and correct