Please complete this form yourself, on behalf of a family member or client to the best of your ability. Fields marked with an asterisk (*) are compulsory. Please note, as you click 'Next' through the sections, you may need to scroll back to the top of each page.
Before you start, please gather information about yourself or the person to help you complete the form; including; contact details, emergency contact details, family and background information, additional identification information (e.g. Medicare number) and medical/mental health conditions.
Once the form is complete you can submit the form directly and confidentially to the Triple Care Farm Intake Coordinator.
Important: Please note that if you or the person has a community-based support worker of any kind (e.g Juvenile Justice officer, Probation & Parole officer, Mental Health Worker, GP/doctor support, Counsellor, Mentor, Social Worker or Case Manager), the 2C Risk Assessment Form needs to be completed by the most relevant support worker and sent to the Triple Care Farm Intake Coordinator in addition to this online referral form.