Consent to Release Information – During the delivery of allied health services, we may need to discuss certain aspects of your child’s therapy plan with other health professionals, doctors, teachers or other parties involved in your child’s care. Correspondence may occur face to face, over the telephone, via mail or email. By signing below, you are providing consent for us to contact relevant parties involved in your child’s therapy activities. I hereby give Scribble Children’s Therapy permission to release information regarding my child. Please note, if you are plan managed, we will need to liaise directly with your plan manager for invoicing and billing purposes.

Scribble Children’s Therapy requires all clients to provide debit/credit card information which will be kept on file. Your private information is securely stored and encrypted in our practice management system. This means, once initially entered and captured, your card details are not visible to anybody within the clinic. Scribble Children’s Therapy reserves the right to use your debit/credit card information for charges incurred for direct and indirect services delivered to you, outstanding account balances, cancellations, missed appointments or outstanding plan management invoices. It is your responsibility to ensure that there are sufficient cleared funds in the nominated debit/credit card by, and at all times on, the due date of the payment to enable the charge to be processed. By selecting “I agree”, you acknowledge and agree that sufficient funds will remain in the account/card and that if there are insufficient funds available when the charges are attempted, you agree that you will be responsible for any fees and charges that may be charged by your Financial Institution or dishonour fees that may be charged by Scribble Children’s Therapy. If the automatic authorisation date falls on a weekend or public holiday the charge may be initiated on the next working day. If your card on file is charged, you will be provided with a receipt.

We may take photos and videos of your child during therapy to record their progress. We will not use your child’s photos for social media and/or advertising. Please advise us immediately if you do not want your child to be photographed or videotaped. I agree to my child being photographed or videotaped for assessment and/or therapy purposes.