Children's Patient Form

Afternate contact Details (In case of unexpected cancellations)

Audioloaical History

By signing below, you consent to the collection, use and disclosure and handling of your personal information in accordance with the Privacy and Consent Notice. (As below)

PRIVACY NOTICE AND CONSENT INFORMATION

PRIVACY POLICY: At Hearsmart, it is our policy to respect the confidentiality of information and the privacy of individuals and the individual's right to access personal information we hold. Our privacy policy is bound by the information Privacy Principles contained in the Privacy Act (Cth). Hearsmart follows the Australian Privacy Principle 5 (APP 5) (updated Privacy Act 1988 (Cth)) and Guidelines for Federal and ACT Government Websites produced by the Office of Federal Privacy Commissioner. When you visit Hearsmart for a hearing test, with your consent, we collect personal information which will be used by us for Quality Hearing Care. We understand that you are happy for us to retain your information for these purposes. If you have any questions or complaints, please contact us.