UniSA Health Clinics – Client Intake Form

A member of our admin team will be in contact with you to provide further information about accessing NDIS support

Assessment and treatment by undergraduate/postgraduate student(s) under the supervision of qualified practitioners.

UniSA Health Pty Ltd using my personal information for the purpose of contacting me, either by phone, SMS, email or mail,  in relation to my health care, notifying me of upcoming appointments and promotions.

UniSA Health Pty Ltd disclosing my personal information to other health professionals, educational staff or significant personnel as appropriate, in relation to the delivery of therapeutic services and/or cross-referrals as required.

UniSA Health Pty Ltd disclosing personal information or data collected during my attendance, or my child’s attendance, at a UniSA Health Pty Ltd service to a third party for the purpose of potentially being used in scientific papers, journals, book chapters or reports that might be published by the third party on the condition that my personal information will remain confidential and I will be in no way identifiable from the data used.

I have read, understood and agree to the UniSA Allied Health Services – Telehealth Information 

I have read, understood and agree to the UniSA Health Telehealth Audio/Visual Recording Information

Please enter your name and date below to confirm your consent to the above. Note: For under 16 year old’s, parent/guardian consent is required.

Your personal information, including your health information, will be used and stored in accordance with the Australian Privacy Principles and UniSA Health Pty Ltd's Privacy Policy.