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Referral Form

Advocacy Referral Form WORD - PDF

Please Note - Completion of a request for advocacy support does not guarantee that your matter will be one that we can undertake on your behalf.

Process

Once your referral is received, you will be contacted for an Intake Assessment in relation to your Spectrum of Vulnerability (SoV) under the National Disability Advocacy Program and your particular advocacy issue. All referrals are discussed at Review Meetings and prioritised based on their SoV. If Independent Advocacy Townsville cannot assist you, we may refer you to an alternative service and/or organization.

PLEASE USE 1 FORM PER PERSON
ENSURE YOU ENTER CORRECT CONTACT DETAILS

ADVOCACY REFERRAL FORM


SECTION A – DETAILS OF PERSON BEING REFERRED



Is there a Public Guardian Appointed?
If a Public Guardian is in place for service provision, we are unable to provide advocacy without their consent.
Is there a Power of Attorney or Enduring Power of Attorney?
Is the Public Trust appointed for financial management?

SECTION B – DETAILS OF EXTERNAL PARTY MAKING REFERRAL

Does the person know and understand and consent to you making this referral?

SECTION C – ADVOCACY DETAILS