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Contoso Limited
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Mediation Establishment Form

Client Detail

 
 
 
 
 
 
 
 

Residential Address

 
 
  

Postal Address

 
 
  

Client Demographics

 
 
 
 
 

Child/ren

Child 1

 
 

Child 2

 
 

Child 3

 
 

Child 4

 
 

Child 5

 
 

Child 6

 
 

Child 7

 
 

Child 8

 
 

Child 9

 
 

Child 10

 
 

 
 
 
 
 

Other Party's Details

 
 
  
 
 
 
  

CatholicCare Consent

Your Right to Privacy

CatholicCare respects your privacy and ensures that any personal information we obtain about you is safeguarded and accessed only by authorised CatholicCare personnel. Your personal information is also protected by law, which CatholicCare is committed to upholding. You can find more information about the relevant privacy legislation and how CatholicCare manages your personal information in our Privacy Policy at www.catholiccare.services or by calling 1300 477 433.

Use and Storage of Personal Information

The information you provide to us includes personal information. CatholicCare ensures your personal information is protected, which includes entering and storing your information into CSnet® (a secure electronic client database). We use your personal information to assist us in providing services to you that best meet your individual circumstances.

We will not share your personal information with anyone else without your consent unless we are required or legally permitted to. For example, we may be required to notify relevant authorities or others in the following circumstances:

  • if we become aware of actual or intended harm (including dangerous self-harm)
  • if we receive information about child abuse or risk of abuse
  • to report the commission, or prevent the likely commission, of an offence involving violence or threat of violence to a person, or of intentional damage to property.
Government Reporting Requirements

The services you will be receiving are partially funded by the Australian Government’s Department of Social Services (DSS). DSS requests personal information about clients who access these services from CatholicCare. With your consent, we provide the required information to DSS via a secure electronic portal called the Data Exchange or “DEX”. Please note: DSS is only able to access de-identified information from DEX, which means your privacy is protected. You can find more information about how DSS manages data and upholds its legal privacy obligations at www.dss.gov.au.

** If you would prefer to access this service from CatholicCare on a private (fee-paying) basis then we will not be required to report any information about you to government departments or other funding bodies. Please review our Fee Statement for detailed information about what fees will apply in these circumstances.

Measuring Our Impact

For CatholicCare to assist you in the best way possible, we will be monitoring your journey with us along the way.

This is a self-appraisal of how you are ‘at the moment’. It will only take a couple of minutes to fill in but will be an invaluable tool for us to assist you through the process and to ensure we are providing the best service to our clients. We are measuring the impact of our service on your independence, participation and wellbeing and your satisfaction with our service.

Rate how satisfied you are with the following:

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We are honoured to be on the ancestral lands of the traditional custodians of this area, the Giabul, and Jarowair peoples. In keeping with CatholicCare’s spirit of reconciliation and respect, we understand that these groups have occupied and cared for this land over countless generations and we celebrate the continuing contribution of these communities to the life of this region. We also recognize and respect those emerging leaders who now claim Australia as their new home.

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