Consent Form

Information Consent

I authorise Dynamic Rehab Group to obtain and release information relevant and in relation to my rehabilitation. This information can be gathered in written, photographic, and verbal mediums. This information will be used to formulate my rehabilitation programme, and to liaise with the agencies listed below regarding my ongoing progression.

• All treating doctors and specialists
• All allied health professionals
• Your Insurer and delegates
• Family members / NOK:
• Care and support agencies, including staff
• House and yard maintenance services
• Equipment suppliers
• Hospitals and/other agencies, including request(s) for medical records and information

Acknowledgement of Service Delivery

I understand that Dynamic Rehab Group utilise Al softwares to assist clinicians with record keeping. I consent to the information being used and stored to assist with the service being offered to me.

I understand that this form may be altered and/or cancelled at any time by liaising with a representative of Dynamic Rehab Group. If the recipient of the rehabilitation programme is under 18 years of age, this component is to be completed by a Parent/ Guardian.

I understand that Dynamic Rehab Group and their representatives are unable to provide crisis intervention. If I require emergency services, I will either attend an Emergency Department or call 000.

Consent to Email Communication

I consent to Dynamic Rehab Group communicating with me and/or my nominated representatives via email, including the transmission of personal, sensitive and health-related information relevant to my care, treatment, appointments, assessments and reports.

I understand that email is not a completely secure method of communication and that, despite reasonable privacy and cyber security measures being implemented, there remains a risk that information may be intercepted, misdirected, accessed by unauthorised persons, delayed, altered, or otherwise compromised during transmission. I acknowledge that no electronic communication system can be guaranteed to be completely secure.

I authorise Dynamic Rehab Group to send reports, assessments, invoices, treatment records, recommendations and other clinical documentation to me and/or my nominated third parties (including insurers, solicitors, rehabilitation providers, support coordinators or authorised representatives) via email where required for the provision and coordination of my care. I accept the risks associated with electronic transmission of this information and understand that I may withdraw this consent at any time by notifying Dynamic Rehab Group in writing.

I authorise Dynamic Rehab Group to request information relating to my care, treatment, and rehabilitation, from other providers, and acknowledge the risks of information being shared by other parties with Dynamic Rehab Group.

Consent to Privacy Disclosure and Duty of Care

I understand that allied health professionals have legal, ethical and professional obligations to take reasonable steps to protect the safety and wellbeing of clients and others where there are concerns regarding risk of harm, abuse, neglect, exploitation, significant mental health deterioration, or other situations requiring urgent intervention.

I acknowledge that, where clinically indicated, Dynamic Rehab Group and its clinicians may disclose relevant personal and health information to appropriate services, including emergency services, mental health services, hospitals, child protection agencies, adult safeguarding agencies, government authorities, crisis support services, or other relevant health professionals, without my prior consent where required or permitted by law, or where necessary to reduce a serious risk to my safety or the safety of others.

By signing below, I acknowledge that I have been informed of these professional obligations and authorise Dynamic Rehab Group to communicate with and provide relevant information to appropriate services when reasonably necessary to support my safety, welfare, treatment, or care coordination, based on my presentation and clinical circumstances at the time.

Note: This consent does not limit or replace the clinician’s legal and professional obligations under applicable legislation, mandatory reporting requirements, privacy laws, or professional standards, which may require disclosure of information irrespective of consent in certain circumstances.