Consent Form Client/Participant Consent Form Lyfetree Therapy and Counselling 1. Your Name 2. Date of Birth MM DD YYYY 3. NDIS Number (if applicable) 4. Contact Number 5. Contact Email 6. Person or organisation you give consent for Lyfetree Therapy & Counselling to share/receive personal information about you 7. Contact number of person or organisation 8. Email address of person or organisation 9. Please specify any information you do not give us permission to share/receive about you 10. Signature Date MM DD YYYY Thank you for providing your consent! Your submission has been received and recorded. Your trust in us is highly appreciated.
