CONSENT TO RELEASE INFORMATION
Read with client/caregiver and answer any questions before obtaining signature.
The signature below serves to authorise that the client understands that the purpose of the referral and disclosure of information to MARSS Australia Inc. to ensure the safety and continuity of care among service providers seeking to serve the client. The referring agency has clearly explained the procedure of the referral to the client and has listed the exact information that is to be disclosed. By signing this form, the client authorises this exchange of information.