Family Wellbeing Referral Form

Baptist Care SA complies with the Privacy Amendment (Enhancing Privacy Protection) Act 2012 and government guidelines*, which set out the rules for handling your personal information. These require Baptist Care SA to have your consent to collect, store and disclose your personal information.

At Baptist Care SA, your personal information:

• is collected and used for the purpose of providing you with a service that is individually suited to you.
• will be stored securely.
• will not be passed to third parties, unless with your express written permission; except when requested by the relevant authorities to protect people (including children) from harm or abuse; or when a person is at risk and for the purpose of providing unidentified data only to the Department of Social Services who fund this program.
• may be accessed by staff associated with your service delivery.
• may be viewed by external auditors to assist with improving the quality of the services provided.
• can be seen by you, at your request through the Freedom of Information Act 1982
• you can withdraw your consent at any time. However, once consent is withdrawn, we are no longer able to offer you services.

Do you consent to this? Please sign the consent on the last page of this document once you have filled out all of the information required within. Filling out all the information as best you can, will help us to expedite your referral to the intake process. Otherwise, your referral could be delayed in getting to the intake team.

If upon receiving the referral form, we identify that the information required for service provision is incomplete, you understand that the referrer and/or parent/guardian will be contacted by one of our administrative staff to complete the referral form, so that it can be sent through to the intake team.

The referral process is to ensure that all relevant information has been provided. This process does not guarantee eligibility to our service.

While eligibility to our service is being assessed, an information pack will be sent out, containing resources on how we can work together in the best interests of children/ young persons, followed by the full consent forms.

Please read them and let us know if you have any questions or concerns. Remember you can withdraw consent and exit our services at any time.


* information collected and used by Baptist Care SA and the Family Wellbeing Service for demographical and statistical reporting purposes, on behalf of the Department of Social Services.