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Privacy collection notice and consent

Example template only. Not legal or clinical advice. Review and adapt before use. Not endorsed by any government agency. Last reviewed 14 October 2026.

Rules differ by state; check yours.

Businesses that collect personal information, including health information.

Written for the Australian Privacy Principles. It says what you collect, why, and who you tell. A tick box asks for express consent before sensitive information, including health information. It does not promise that data stays in Australia.

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Privacy collection notice and consent

Example template only. Not legal or clinical advice. Review and adapt before use. Not endorsed by any government agency. Last reviewed 14 October 2026.

We collect your name, contact details and the answers on this form so we can provide the service you asked for and keep a record of it.

We may share those details with staff who do the work, and with a referrer or insurer if you ask us to. We do not sell the details.

Fields

  • Who is collecting

    Your business name and a contact email. We leave these blank for your brand.

  • What and why

    The kinds of details, and the job they are used for.

  • Who else sees it

    Staff, a referrer, or a fund, only where you actually share it.

  • Sensitive information

    An express consent tick. Notice alone is not consent.

  • Signature

    The person signs on the phone.

Questions

Which law is this aimed at?

The Australian Privacy Principles. Private providers in Victoria, New South Wales and the ACT also sit under the Health Records Act, the HRIP Act, and the Health Records (Privacy and Access) Act. Rules differ by state; check yours.

Does it say my files stay in Australia?

No. Only say that if your setup actually keeps them here.

About these templates

These templates are examples only, to help you get started. They are general information, not legal, medical, clinical or professional advice, and they may not suit your business, your profession or your state or territory.

Before you use any template, you must review and adapt it, and have it checked where needed, so it fits your services, your professional body's rules, privacy and health records laws, and the law where you operate. This matters most for consent, waiver, privacy and minors' forms. You are responsible for the forms you use and the information you collect.

To the extent the law allows, Nopen gives no warranty that the templates are complete, current or fit for any purpose, and is not liable for loss arising from their use. Nothing here excludes, restricts or modifies any right or remedy you have under the Australian Consumer Law that cannot lawfully be excluded.

The templates are not endorsed by or connected with any government agency, including Services Australia, Medicare or the NDIA. Do not add government logos, the Commonwealth Coat of Arms or other official marks to them. Fields that refer to government numbers (such as a Medicare card number) are labels only.

Templates were last reviewed on 14 October 2026. Laws change, so check that a template is current before you rely on it.

Example template only. Not legal or clinical advice. Review and adapt before use. Not endorsed by any government agency. Last reviewed 14 October 2026.

Drafted 14 October 2026.