RELEASE OF INFORMATION FORM
Organisations, schools, health professionals and others who need to pass on a person's personal information regarding their epilepsy or their child's epilepsy, either to the Foundation or to another entity, can use the authority form below to do so.
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:
- fax it to the Foundation on 03 9882 7159
- mail to 818 Burke Road, Camberwell Vic 3124 or
- scan and email to epilepsy@epilepsy.asn.au
Further information:
For further information or assistance in making a referral, kindly telephone the Epilepsy Helpline 1300 852 853.
