RELEASE OF INFORMATION FORM
Organisations, schools, medical professionals and others who wish to refer to the Epilepsy Foundation, or who need to pass on a person's personal information in relation to their epilepsy or their child's epilepsy, either to the Foundation or to another entity, can use the Authority to Release Information form to gain permission.
Complete electronically
Authority to Release Information form (Word document) - download and complete this form electronically (you can print and save it too) and email to epilepsy@epilepsy.asn.au
Complete manually
Authority to Release Information form (pdf) - download and print, then complete the form in writing, and either:
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fax it to the Foundation on 03 9882 7159
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mail to 818 Burke Road, Camberwell Vic 3124 or
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scan and email to epilepsy@epilepsy.asn.au
Further information
For further information or assistance in completing this form, kindly telephone the Epilepsy Foundation (Melbourne metropolitan) on 9805 9111 or the Epilepsy Helpline (regional Victoria) on 1300 852 853 for the cost of a local call.
