Access to Client Records Form

Client Details

This service is only available within South Australia. Check our services page for specific locations. Or contact Head to Health directly on 1800 595 212 or visit website www.headtohealth.gov.au for alternative services in their area.

Applicant Details

Details of Request

YesNo
a) I wish to inspect the documents
Yes
No
b) I require a copy of the documents
Yes
No
c) I require access in another form
Yes
No

Client Consent to Release Information

Information will not be released to 3rd party unless consent has been authorised below by client.
Clear Signature
Clear Signature
I, (client / guardian) hereby consent to the release of information as requested.
Click or drag a file to this area to upload.
Please upload a copy of your current photo identification