DFS - Clients - Consent for AI Audio Transcription Form

Consent for AI Audio Transcription Form

Client Email Address *

This permission is to be granted for the following duration of time:

For the duration of treatmentUntil revokedUntil specified date

By whom? *

What date? *

Dates / sessions to be excluded from recording(If applicable)

Choose your nearest DFS clinic *

We would be grateful if you would fill in this form to give us permission to transcribe you / your child’s appointments and consultations at Direct Focus Solutions using an audio transcription software.

These transcriptions are conducted through Splose, our client management software, using the platform's AI audio transcription technology. The recording is used to generate a transcript that can be utilised by the treating practitioner in order to help compile progress notes and report data.

Splose is compliant with Australian privacy and data policies (as it uses industry-standard AES-256 encryption to maintain SOC 2 compliance.) Your recording and transcript will be stored securely on our system in compliance with the organisation's privacy and confidentiality policies. You may request to see these policies at any time if you require further information.

By signing this form, I give permission for Direct Focus Solutions (DFS) to:

Take audio recordings of myself / my child during appointments and consultations *

Maintain a secure copy of any recordings taken for the duration of the client’s services at DFS *

Transmit a copy of recordings to one or more of the individuals listed below: *

1. *

2.

3.

4.

5.

Name of Client *

Client Signature

(As applicable)

Name of Parent / Guardian(As applicable)

Parent / Guardian Signature

(As applicable)