Consent Form

Please Submit this form prior to your appointment with Capable Kids.

    I consent for Capable Kids South Coast (CKSC) to contact and exchange information with the following services in regards to my child (please tick):
    I also acknowledge I have received, read and consent the CKSC Privacy Policy and Attendance & Cancellation Policy.
    I consent to the use and collection of my child’s personal information.


    Preschool / School teacher / Principal

    Name/ Organisation



    General Practitioner

    Name/ Organisation



    Paediatrician / Other Medical Specialist

    Name/ Organisation



    Other Health Professional (OT, SP, Physio, Psychologist)

    Name/ Organisation



    Plan Manager

    Name/ Organisation



    Case Worker

    Name/ Organisation



    NDIS Contact

    Name/ Organisation




    Signed
    Print Name