Consent to use information


The Little Black Duck Autism consultation, education, support, and individual skill development

Consent to use information

Find out how we use your information

Consent to use information

By agreeing to this form you are agreeing that you have read the above information and understand the reasons for the collection of your personal information and the ways in which the information may be used and disclosed and agree to that use and disclosure.

The Little Black Duck needs to collect information about you for the primary purpose of providing a quality service to you. In order to thoroughly assess, diagnose and provide therapy, we need to collect some personal information from you. If you do not provide this information; we may be unable to treat you. This information will also be used for:

  1. The administrative purpose of running the practice;
  2. Billig either directly or through an insurer or compensation agency;
  3. Use within the practice if discussing or passing your case to another practitioner for your ongoing management;
  4. Disclosure of information to your doctors, other health professionals or to teachers to facilitate communication and best possible care for you;
  5. In the case of insurance or compensation claim it may be necessary to disclose and/or collect information that concerns your return to work to an insurer or your employer.
  6. In consultation with the NDIS

We do not disclose your personal information to overseas recipients.

The little black duck has a Privacy Policy that is available on request and is available on our website. That policy provides guidelines on the collection, use, disclosure and security of your information. The Privacy Policy contains information on how you may request access to, and correction of, your personal information and how you may complain about a breach of your privacy and how we will deal with such a complaint.

To ensure the process of quality treatment provision, information about your assessment results and progress may be given to relevant other service providers, who are involved in your management. These may include your doctor, teachers, specialists, insurers, solicitors or employers.

  • I understand that it is my choice as to what information I provide and that withholding or falsifying information might act against the best interests of my assessment and therapy progress.
  • I am aware that I can access my personal and treatment information on request and if necessary, correct information that I believe to be inaccurate.
  • I understand that if, in exceptional circumstances, access is denied for legitimate purposes, that the reasons for this and possible remedies will be made available to me.
  • I have been provided with or have been given an opportunity to obtain a copy of the little black duck’s privacy policy.

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Contact Us

Address: 418 Wilson St, Albury
2640

By Appointment Only
Monday & Tuesday: 9.30am – 9.30pm
Wednesday: Closed
Thursday & Friday: 9.30am – 3.30pm
Saturday: 10am-2pm

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Click here to book an appointment online

Autism consultation, education, support and individual skill development
© The Little Black Duck 2021 – not to be copied, edited or reproduced with out permission. All rights reserved.  ABN: 24 070 499 125