Application to amend or alter personal information
How do I make a request to amend or alter my personal information?
Under the Privacy Act (1988) you are able to make a request for Therapy Focus to amend or alter your
personal information if you believe this information to be incomplete, incorrect, out of date or misleading.
To make a request, you need to do the following:
1. Put your request in writing. You can use this form, or send a letter detailing your request either by post or
email
2. Identify the information or documents containing your personal information which is incomplete,
incorrect, out of date, or misleading
3. Provide the reasons why you believe this information is incomplete, incorrect, out of date or misleading
4. Include an address to which notices of information may be sent. If you do not have an Australian postal
address, please provide an email address by which Therapy Focus is able to contact you
To assist Therapy Focus to process your request, provide as much supporting evidence and original
documentation as possible.
Where can I go for help?
If you need assistance in completing an application to amend or alter your personal information, please
contact the Privacy Officer in the following ways:
 Mail: The Privacy Officer. Therapy Focus, PO Box 20, Bentley WA 6982.
 Phone: 1300 135 373
 Email: [email protected]
What will this request cost?
Nothing. There are no charges for requesting an amendment or annotation of your records.
Proof of identity
We need to ensure that you are who you say you are, before releasing your personal information. To ensure
your records are securely maintained you should attach a copy of photographic identification such as a
passport or driver’s licence. If you are acting on behalf of another person, including a child under 18 years of
age, please include their photographic identification (only if available).
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Where do I send my request?
Applications may be submitted in a variety of ways, including:
 In person: 5/1140 Albany Highway, Bentley WA 6102
 Mail: The Privacy Officer. Therapy Focus, PO Box 20, Bentley WA 6982.
 Email: [email protected]
When can I expect to be informed of the decision?
We will notify you of our decision within 30 days. Therapy Focus will contact you as soon as possible if we
do not agree to amend or alter your personal information in the manner that you have asked.
Right to request review and/or notation
If Therapy Focus decides not to amend the information in accordance with the application you may, in
writing, request Therapy Focus to review the decision and/or to make a notation or attachment to the
information. In this case, you must give details of the matters in relation to which you claim the information
is inaccurate, incomplete, out of date or misleading; and if you believe the information is incomplete or out
of date — set out the information that you believe is needed to complete the information or bring it up to
date.
Complaints
If you are not happy with how we have handled your request, please contact us directly so that we can try
and address your needs. If you do not receive a response within 30 days or if you are unhappy with the
response/outcome you can complain in writing to the Office of the Australian Information Commissioner
(OAIC):
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By the online Privacy Complaint form
by mail: GPO Box 5218 Sydney NSW 2001
by fax: (02) 9284 9666
by email : [email protected]
Important information about privacy
This application form collects personal information about you and if applicable, the person that you are
seeking information about. We require this information under the Privacy Act (1988) to process your
application. The information provided by you will be held by Therapy Focus electronically, on a secure server
held on-site. Your personal information will not be disclosed.
If you would like more information, please contact the Privacy Officer on [email protected] or
1300 135 373.
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1. Your Personal Information
Surname:
Given names:
Australian postal address:
Contact phone number:
Email:
2. Information about your child(ren) (only complete if relevant)
If this application is seeking information about your child(ren), under the age of 18 years, in your role as
parent or guardian - please provide the full name of your child(ren) and their date of birth(s) below.
Name of child(ren):
Date of birth(s):
3. Information about someone you are authorising to act on your behalf (only complete if relevant)
If you would like to authorise someone to act on your behalf (or your child’s behalf) in regards to this request,
please provide their details below.
Name of person
Postal address (in Australia)
Contact phone number or email
Relationship to you:
Declaration:
I hereby authorise__________________________________________________ whose signature appears
below, to act on my behalf, receiving all communications with regard to this request
x
Signature of person who will act on your behalf
Date:
x
Signature of person making application
Date:
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4. Your request for amendment or alteration
a. Which Therapy Focus records or information do you believe are incomplete, incorrect, out of date, or
misleading? (Please include file numbers if known)
b. Give reasons why you believe the records or information are incomplete, incorrect, out of date, or
misleading
c. Is there any other information which you think will help Therapy Focus to make a decision including any
previous requests? Please provide details.
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d. List the documents you are attaching as supporting evidence (ORIGINAL documents will be returned to
you)
e. What do you claim is the correct information?
f.
In which ways do you wish the amendment to be made? (please tick all that apply)
Altering information
Inserting information
Striking out or deleting information
Inserting a note in relation to information
Please provide details below:
Please sign (or initial) to indicate that you approve Therapy Focus to process your application and keep your
personal information on our secure system.
Applicant’s signature____________________________________________
Date........./........../..............
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