Lucinda ANTSA Client Consent Form

ANTSA Client Consent Form

Your Child's Full Name *

Your Child's Date of Birth *

To assist clients in tracking and completing therapeutic activities between sessions, and to provide easy online access to resources in one place, your therapist is implementing ANTSA. ANTSA is a digital platform that allows clients to access structured tools such as mood tracking, assigned therapeutic activities, and psychoeducational resources to support engagement with therapeutic work between sessions.

This platform does not replace therapy or your relationship with your prac oner. Rather, it is designed to support the work that occurs between sessions and help maintain connection, engagement, and continuity as part of your ongoing care.

Importantly, participation in ANTSA is an optional, opt-in service offered by your practioner. Please read the following information and indicate at the end of the document whether you would like to utilise this service.

Privacy and Confidentiality
ANTSA protects personal information in accordance with Australian privacy laws, including the Privacy Act 1988 (Cth) and the Australian Privacy Principles.

Data Collection and Use: ANTSA collects personal information necessary to provide services. This may include your name, contact details, and any informa on you provide during your use of the platform.
Data Security: Robust security measures are implemented to protect your data from unauthorised access, modification, or disclosure.
Data Sharing: Your personal information will not be shared with third parties without your explicit consent, except where required by law.

For detailed information, please read the Privacy Policy and Terms & Conditions when you sign up to ANTSA.

Additional Considerations

Emergency Situations: ANTSA is not designed for crisis intervention. In case of an emergency, please contact emergency services or reach out to your clinician directly.
Technical Requirements: Access to ANTSA requires an internet connection and a compatible device. Any costs associated with these are your responsibility.
Withdrawal of Consent: You may withdraw your consent to use ANTSA at anytime by notifying your clinician or contacting us directly. Upon withdrawal, we will cease collecting new data but may retain existing data as required by law.

Consent to Use ANTSA
By signing this form, you acknowledge that:

You have read and understood the information provided about ANTSA.
You agree to use ANTSA as part of your therapeutic process.
You understand that ANTSA is a digital platform and that while we strive to maintain the highest standards of security, no system can guarantee absolute security.

Please indicate your consent below for the use of ANTSA. *

Yes, I consent to the use of ANTSA as part of my therapy. No, I do not consent to the use of ANTSA as part of my therapy.

Section A: For Participants Under 18 Years (Parent/Guardian Consent)

I have read and understood the above ANTSA Client Consent Form. I have indicated above, by ticking the appropriate box, my consent for my child's engagement with this service.

Section B: For Participants 18 years or Older

I have read and understood the above ANTSA Client Consent Form. I have indicated above, by ticking the appropriate box, my consent for this service.

Name of Parent/Guardian

Name of Client/Child *

Signature *

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Date *