Client Consent Form

• This consent form is relevant for all Bayley House Services.
• It should be completed prior to service commencement and must be reviewed annually or as needs and services change.
• It should be read in conjunction with the Client Rights Documents. In particular the Privacy And Confidentiality Policy and the Management of Monies Policy
• Permission and consent may be withdrawn or amended at any time on receipt of a written request or by completing this form again.

Authority to obtain or release information

I agree that Bayley House may obtain or disclose information about our clients (including personal information or health information) with Bayley House staff and external service providers. I understand that information about the client will only be obtained or disclosed for purposes relating to the provision of services to the client by Bayley House, including to government departments and agencies and other funding bodies where it is required to disclose that information under a law or agreement with that department, agency or body. I acknowledge that this will include allowing quality auditors to access information about the client. Any information about the client received by Bayley House will be treated as confidential.

I have read and understood the Bayley House Client Privacy Statement and consent to the personal and health information relating to the client named above being collected and dealt with in accordance with the Client Privacy Statement. I have informed Bayley House of specific instances where consent will not be granted by completing point 2. above.

(Please complete this section if using Accommodation & Respite Services)

I declare that I have been provided with, read and understand, or have had read and explained to me, Bayley House’s Management of Resident Monies Policy and I consent to Bayley House managing money for the client named above, within the specifications and guidelines of the Disability Act (2006) and the Bayley House Management of Resident Monies Policy