NDIS Consent Form

Consent to Share Your Information

Please use this form to give your permission (consent) for the National Disability Insurance Agency (NDIA) to share your National Disability Insurance Scheme (NDIS) information with a person or an organisation of your choice. For example, you may wish to share some or all of your NDIS information with a family member who helps you make decisions or with a provider you regularly engage with.

Participant Details

First Name

Last Name

Date of Birth

Email Address

Phone Number

NDIS Number

Nominee Details

First Name

Last Name

Date of Birth

Email Address

Phone Number

Relationship to Participant

Acceptance of Terms

By ticking the boxes and signing below I acknowledge that:

I have read, understood and give consent as indicated in the NDIS Consent Form

Participant and/or Authorised Person's Name

Signature (to be affixed to the agreement and consent form)

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