Pindari Resident Application

I understand that, in evaluating my suitability for the program, Pindari Restoration House management may contact health professionals for advice and/or make contact with my family/next of kin. I give permission for Pindari Restoration House to obtain relevant information from medical practitioners, other agencies and/or medical health professionals and share this information in order to assess this application and future treatment. This includes, but is not limited to, results of all blood test and urine analysis and investigations, diagnosis of any medical conditions and prescriptions of any medications including any information on My Health Record.

I agree to allow my medical practitioner and/or psychiatrist and/or psychologist to share information with Pindari Restoration House regarding any physical or mental health conditions I may have. I understand that this information will be kept confidential.

I hereby state that the information I have provided in this Application Form is true and correct and that if I have purposely provided false information that I will be dismissed from the program even after acceptance.