I understand that if there are any safety issues that affect me or my child’s safety, the Tupu Aotearoa Mentor/Talanoa Ako Coordinator/Stop Smoking Service/Pacific Access and Choice (Wellbeing & Mental Health Support, 1:1 and Group Brief Intervention)/CPCT Health Navigation/Kaiawhina maybe required to contact the appropriate support services and agencies including Waitaki Mental Health Services, Police, Oranga Tamariki and any other agencies as approved.

I understand that that the personal information collected from me by OPICG as part of their social service delivery is being collected only for the purposes and administration of that service delivery and or other interventions and services relevant.

I understand that information I provide is provided voluntarily and there are no consequences for me if I do not provide all the information requested (although it may affect the level of service I receive).

Under the Privacy Act 2020 and the Health Information Code 2020, I understand I have a right to access to my personal information held by OPICG. I also have a right to request correction of information held by OPICG that I think is not correct.

I give permission under the Privacy Act 2020 to provide information collected from me as part of the specific service delivery from OPICG to:
-my family (name specific family members)
-my GP / healthcare provider
-Employment agencies
-education and training providers

Information on this form is kept confidential and sent to the Chief Executive Officer who will then allocate to the specific service requested. Contact will be made with the Client and we will go through a Consent process with them to outline the service provided, privacy, collection and access to their information.