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At Young Mindz, we promise to provide the Young Mindz style of care for all our Referral Partners, Clients, and their loved ones.

 

 

Support Referral

Need support from a team who truly understands what you need? We’re here to support you with reporting, evidence building, and qualified support care for participants.

Referral Form

National Number: 1300 356 395

Email: hello@youngmindz.com.au

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Referrer Details

Who is the person filling out this form? *

Participant Details

Gender *
Do we have permission to contact the participant directly?

Plan / Support Details

Support worker requirements *
Is the participant on a forensic or treatment order? *
What support ratio is the participant needing? *
Does the participant have a Behaviour Support Plan? *
What is the participant's funding source? *
How are the participant's funds managed? *
What services are needed? *

Health and Wellbeing

Please indicate participant's diagnosis/disability *
Please indicate any behaviours of concern *
Please indicate any health conditions or concerns *

Contacts / Stakeholders

Does the participant have an appointed guardian?
Do we have consent to contact the guardian directly?
Who are the current stakeholder's or specialists involved? *
Does the participant have a Public Trustee? *

Please attach PBSP, Health Management Plans, and allied health documents.