headspace Sharing Personal Information Disclosure Form

As part of our role assisting young people who may or may not be experiencing mental health symptoms, we are able to liaise with employers and education providers to ensure adequate supports are negotiated.
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.

Using the fields below, please discuss thoughts about the advantages and disadvantages of sharing personal information with employers/education providers.

Let’s discuss your options:

• Your vocational specialist contacts employers providing no personal information other than they are supporting you to look for suitable employment.
• Your vocational specialist contacts employers on your behalf. When job-matching, they may disclose agreed personal information to the employer relating to your individual health needs, i.e. reasonable adjustments like time off work to collect medication. Under this option the employment specialist does not have to share ALL of your health information. You can choose what you would like them to share.
• Your vocational specialist would have no direct contact with a potential employer, however they would support you behind the scenes with your resume, job applications, and other employment search related activities.
• You can choose to market your skills and attributes to a potential employer independently and choose what health information you are willing to disclose, with or without direct support.
• You may opt for a combination of the options above. Your choice matters when sharing your personal information. You have control over what works best for you and you can change your mind at any time.
• If you do decide to share medical information with an employer you can choose when this happens, for instance when applying for a job, at the interview stage or once you have negotiated and secured a job.
Clear Signature
Please use your mouse to sign

**This consent form is valid for 12 months