I understand that:
• All personal information I share with Te Puna Ora o Mataatua will be dealt with according to the Privacy Act 2020.
• Any information collected and recorded about me is for Te Puna Ora o Mātaatua to provide services to me and my family/whānau.
• All personal information I share with Te Puna Ora o Mātaatua will only be shared with other agencies with my permission or if Te Puna Ora o Mātaatua are required by law to release that information.
• Measures will be taken to ensure that my personal information and records will be kept safe and secure.
• I have the right to ask to see all information Te Puna Ora o Mātaatua holds about me and to correct or update that information if it is not accurate.
• Information about my whānau/family may be used for statistical purposes, but only information that does not identify any member of my family/whānau.
• I consent to Te Puna Ora o Mātaatua accessing the national database to source my NHI number.
• I can decide to no longer take part in Te Puna Ora o Mātaatua at any time.
• I have the right to make a complaint about Te Puna Ora o Mātaatua through a formal complaint procedure.
• I am entitled to a copy of this consent form.
• If I know any kaimahi from Te Puna Ora o Mātaatua on a personal level, I can request that my involvement and all information that I share with Te Puna Ora o Mātaatua be kept confidential from that/those particular kaimahi

I have read the privacy statements above and I understand how my whānau/family’s personal information may be used and our rights while engaging with Te Puna Ora o Mātaatua.
I declare that all of the information that provide throughout my engagement with Te Puna Ora o Māatatua is, to my knowledge, true and correct at the time of disclosure.