Unfortunately, this service is only for Determined2 participants. Thanks

With your permission we can link Determined2 with your other providers making collaboration easier. For example, they can receive a copy of your support plan, session feedback and session notes. 

In most cases this will give your chosen provider the opportunity to know more about your time with us, give recommendations on how we can best assist you and additionally share any information about the services they provide for you with Determined2.

To complete this form you will require:

• The name of the provider you wish us to connect with
• The providers contact number 
• The providers email address 

Unfortunately, this service is to link Determined2 to one of your service providers. Thanks

Once this form is submitted, we will send a copy of your support plan to {nameOf} for their records.
Your support plan includes basic information about you and your needs within our service, this is usually information collected at your first session or Meet and Greet.

We can include extra information that will give more details about you and your sessions, you can choose to add these next.
We highly recommend choosing these extras when linking to another health service like an Occupational Therapist, Physiotherapist or Exercise Physiologist as this information will allow them to build on the work that you are doing in our service and assist them with making more detailed recommendations.

Privacy and Your Information

Determined2 is committed to protecting your privacy. We collect and handle personal information that you provide on this form to develop your personal plan.

Determined2 will only use your information in accordance with relevant privacy and other laws. For us to provide the best possible service, we may need to share your personal information with others, we will seek your consent to do so where required.

If you wish to contact Determined2 about the information that you provide on this form, please call 0417 932 466 or email admin@determined2.com.au

You also have the right to access your information and seek its correction under the Freedom of Information Act 1982. For information about making a Freedom of Information (FOI) application, please contact the Office of the Australian Information Commissioner on 1300 363 992.

If you have a complement or complaint about Determined2 please click here https://determined2.com.au/compliments_or_complaints/

You can also give feedback to the NDIS Commission:

They take feedback or complaints about services that you are not happy with. You can call them on: 1800 035 544

Your Information Release

I give consent for my information to be obtained / released as indicated above. I understand that this consent will remain valid until the expiry of my current service plan.

I understand that my information can be shared without my consent, provided:

It is unreasonable or impracticable to seek consent; or consent has been refused; and

The disclosure is reasonably necessary to prevent or lessen a serious threat to the life, health or safety of a person or group of people

If you would like to connect more than 1 provider please submit an individual 'Connect a Provider' form for each provider (for example; if you would like to connect 3 providers, fill out this form 3 times for each individual provider).