Agreement for wider disclosure form

Agreement for Wider Disclosure
There may be times when it is in your best interests for me to be able to share relevant information about you with others. Before I can discuss, or pass information to anyone, I require your explicit consent indicating that you are happy for me to do so.

It is important to note, that any information that is shared with others would only be done on a “need to know” basis or at your request. It is also important to note that once I have shared any information, I am unable to control where the receiver would record this or if they pass any information on to any other individuals.

By completing and submitting this form you are giving your permission that I can pass/disclose information to the teams/agencies/individuals you have indicated.

Should you wish to change this agreement at any time in the future, please let me know so I can review this with you.
Before submitting any information, please take time to read the privacy statement which outlines how your personal information is processed and managed.

Once you have read the privacy notice which can be accessed on the weblink below, please return to complete the remainder of this form

https://pauljharries.com/privacy-notice
If you feel unable to consent to the processing of your information as outlined in the privacy statement, please contact Paul directly to discuss your concerns.

Please sign to give explicit consent for information to be shared with the individuals/agencies/teams stated if required*
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Your details will be sent to Paul in a secure format once you click submit form.
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Agreement for Wider Disclosure