Directed contact consent

We always liaise with a Participant directly, unless they have asked us not to liaise with them, but to instead liaise primarily with a Directed Contact who will act on their behalf. 

In completing this form, you are requesting MND NSW to communicate firstly with person listed below (your Directed Contact) instead of you. MND NSW may communicate with this person about your care needs and this person may act on your behalf (valid 3 years).

This person may be your spouse, partner, daughter, son, family member, friend, primary carer or other person very involved in your care and support.

You can at any time withdraw, make changes or update your consent by contacting MND NSW ph. 1800 777 175  or email infoline@mndnsw.org.au. You can view our privacy policy here or ask for a copy to be posted to you. 

Questions marked * will require an answer.