JAS Client Consent Form You can say YES. You can say NO. It is up to you.Ask questions if you do not understand or feel you want more facts. JAS Client Consent Form Full Name * Date * Client ID Age * I agree for JAS to support me (tick the boxes that apply): when I am at Court at the Police Station in my Legal appointment Share info I give my consent to the JAS to share information about me or my case to my lawyer, the Court or the Police. Information will help others understand my disability so I can understand what is happening in my case. Get info I give my consent to the JAS to get information from services and to share information with services to support me achieve my goals. Name and telephone I agree my name and telephone number can be given to the researchers so I can give my feedback on JAS support. Case info I agree my case information can be given to the researchers and understand my name will stay private. Consent time I understand this consent is only effective when I am a client of the JAS or for 12 months. Don’t share info I do not want the JAS to share any information or talk to the following people or services. Excluded Services/People Declaration I have explained the meaning of this form to the client and declare the record of their consent is accurate. Name of person explaining this form * Client Signature Clear Date * Submit
