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Send Us Your Referral

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By completing our referral form, you will assist our Open Minds staff to understand your needs and direct your enquiry - whether you are an individual, a family member or carer, or a professional. Please complete and submit the below form, and an Open Minds staff member will be in touch within 48 hours. Alternatively, please print the PDF version of the Referral form below, complete and return by fax to (07) 3896 4200 or email to referrals@openminds.org.au

Date of referral

PARTICIPANT DETAILS

  • Yes
  • No
  • Yes
  • No
  • Yes
  • No
  • Yes
  • No
  • Phone
  • Mobile
  • Email
  • Letter
  • Via Referrer

DIAGNOSES, RISKS & OTHER INFORMATION

CONSENT

  • Yes
  • No

REASON FOR REFERRAL (TICK ALL APPROPRIATE BOXES)

  • Acquired Brain Injury
  • Alcohol and Drug Use
  • Carer Request
  • Centrelink
  • Cognitive Issues
  • Criminal Justice
        Involvement
  • Culture and Spiritual
        Issues
  • Department of Child
        Safety
  • Disability Services
        Needs Assessment
  • Employment
  • Financial
        Management
  • Frequent Presenting to
        ACT / HHS
  • Homeless Housing
  • Intellectual Disability
  • Living and Life Skills
  • Mental Health
  • Physical Disability
  • Pyschological Needs
  • QCAT Involvement
  • Risk to Self / Others
  • Rural Community
  • Transition Form Care
  • Transport
  • Other
Are you in immediate danger or need support now? Call Triple Zero (000) or go to a hospital.
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