Release of information consent form

Owned by Christopher
Last updated: Feb 27, 2024
2 min read
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This form is for clients who wish to access their client file and notes. Converge International retains information collected directly from clients as case files and client call and booking records (Personal Information). Clients have the right to request access and/or alteration to, or deletion of their Personal Information.

  • Legislation and industry standards may prevent Converge International from complying with your request. For example, the Health Records Act in your state may not allow the deletion of your case notes, and the Australian Psychology Society Code of Ethics may prevent the release of your notes where doing so is likely to cause more harm to you or others.

  • You also need to know that under no circumstances does Converge provide additional reports for lawyers, courts or tribunals. The only information that Converge will release is your case notes or attendance record.

  • You should be aware that under normal circumstances Converge does not release any information to third parties. This means that requests from lawyers for information will still require this form to be completed, with all information released directly to the client.

  • Furthermore, case note searches and delivery of information can take up to 4 weeks. Converge will endeavour to do its best to meet all required client timeframes, however at no time can Converge guarantee to deliver information by a certain date.

  • Lastly Converge will make all efforts to locate all corresponding files but cannot guarantee that it will be able to locate or release your file. You should not take any action that relies on the location and release of your client information.

Please complete the following:

  1. Open the PDF below

  2. Click the download icon at the top corner to download to your device, then complete on your device or print and scan and complete

  3. Please forward the above signed document to privacy@convergeintl.com.au

 

Our Privacy team will contact you with your requested information. As noted in the form, it can take up-to 4 weeks for Converge International to process your request.

Need more help?

You can call us on 1300 687 327 and we’ll assist you with your enquiry.