Adult Enrolment Form

Welcome to Hear and Say – please complete the below form as your official enrolment into the program.

We work in collaboration with world-class researchers to advance our knowledge and provide the evidence-base to underpin our work and improve outcomes of our adult clients, children and families.  

By indicating my consent and signing this form, I grant permission for the following general research-related activities that have been approved by the Hear and Say Research and Ethical Advisory Committee:

• Access to my/my child’s medical, speech, language and hearing data that are documented in my/my child’s file.

• Data sharing of my/my child’s results between projects.

• Data sharing with First Voice, a national and global alliance of which Hear and Say is a member.
  

In doing so, I understand that:

• No identifying information regarding my child or myself will be divulged; that any data collected will not be published or presented as to reveal my/our identity; and my/our privacy will be maintained at all times. 

• My/our participation is completely voluntary and that I may terminate my/our involvement in the studies at any time, without this affecting my/my child’s ongoing enrolment at Hear and Say.

• Although the purpose of the research projects is to improve the quality of services for adults and children with hearing impairment, our involvement in the research may not result in any direct benefit to myself or my child.

• Separate consent will be sought from me for inclusion in any research projects requiring active participation by me and/or my child.

• I have the opportunity to raise any particular concerns relevant to the participation of my child and/or myself in research and to request project updates.

Under certain circumstances, Hear and Say may offer the opportunity for telepractice-based (online) consultations instead of in-person with a clinician.

We will not provide personal information to any other individuals or organisations without prior consent except where required by law to do so. At times, we may also disclose information on a confidential basis with:

• Your clinician/specialist must maintain confidentiality and privacy standards during sessions, and in creating, keeping and transmitting records.

• At times, audio and video recordings of sessions may be taken to support the clinician/specialist’s work, as may occur in centre-based consultation. You will be informed before a recording takes place and can refuse to be recorded for any reason. Your clinician/specialist will inform you of the reason for the recording and how it will be stored and used.

• While your clinician/specialist is obligated to meet standards to protect your privacy and security, telecommunication, including videoconference, may increase exposure to hacking and other online risks; as with all online activities, there is no guarantee of complete privacy and security protection. You may decrease the risk by using a secure internet connection, meeting with your clinician/specialist from a private location, and only communicating using secure channels.

• You can ask about alternatives to telepractice at any time. If you refuse or change your mind about telepractice services, your clinician/specialist can discuss any other options with you. Your clinician/specialist may or may not be able to offer alternative services.

Hear and Say is committed to ensuring the protection of your personal information. The following summary outlines how we collect, handle, store, and disclose your personal information, in accordance with applicable privacy laws and best practice standards.

We will collect, hold, and use your personal information to provide you with relevant services, including but not limited to:

• Early Intervention (Listening and spoken Language Therapy)

• Audiological (Hearing) Management

• Medical Management
  

• Allied Health Services

• Rehabilitation/Habilitation

• Speech Pathology

• Group programs

• Associated Administrative Purposes (such as external auditing)

We take reasonable steps to ensure that your personal information is protected from misuse, interference, and loss, as well as unauthorised access, modification, or disclosure.

We will not provide your personal information to any other individuals or organisations without your prior consent, except where required or authorised by law. However, we may disclose personal information on a confidential basis to the following parties:

• Contractors: We may share information with contractors who assist Hear and Say with services such as database management, printing, and mailing.

• Overseas Recipients: In certain situations, we may disclose your information to overseas recipients, for example, a medical practitioner in another country, if you are using our health services and reside outside Australia.

• Emergency Services: In the event of an emergency, we may disclose your personal information to relevant emergency services personnel.

You have the right to request access to your personal information and to ask for it to be corrected if it is inaccurate, out of date, incomplete, or misleading.