About this resource
This form records informed consent, including what is proposed, risks, alternatives, fees, and the right to withdraw.
Purpose
A plain-language consent form for allied health assessment and treatment, with fees and privacy.
Who it is for
Primary profession: Allied health and multidisciplinary teams. Also relevant for occupational therapists, speech pathologists, psychologists.
Client or participant group: Practitioners and teams.
Practice setting: Allied health practices.
Suggested uses
- New clients
- New treatment
- Student clinics
Instructions for practitioners
- Add your details and delete what does not apply.
- Check it against your professional requirements.
- Explain it to the person in plain language.
- Store completed copies securely.
Accessibility considerations
Clear headings and tables. The Word version can be edited and filled in on screen.
Scope and limitations
A template for adaptation. It is not legal advice. Check it against your professional body's requirements, your insurer's advice and the law where you work.
Research basis
Health service providers must handle health information in line with the Privacy Act and Australian Privacy Principles, including telling people what is collected and why, and obtaining consent where required.
- Office of the Australian Information Commissioner. Guide to health privacy. https://www.oaic.gov.au/privacy/privacy-guidance-for-organisations-and-government-agencies/health-service-providers/guide-to-health-privacy
What is included
A 2-page printable A4 PDF, including a practitioner notes page with the research basis (version 1.0).
Originality
Original Practitioner Plus content: wording, activity structure, layout and icons were created for this resource. No third-party worksheets, illustrations or text were reproduced. Written for Practitioner Plus from the sources in the research basis.
