Registration / Referral Form
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We are committed to protecting your privacy and know it is important for you to understand how your information is handled.

In submitting the information contained in this form, You:
Consent

REFERRER DETAILS

PARTICIPANT DETAILS

Person consents to share Information
Person consents to Contact

HEALTH, MENTAL HEALTH, DISABILITY AND/OR SUBSTANCE USE

FUND ALLOCATION DETAILS

Funding Categories-

  1. Improved Relationship/ Behaviour Support

CULTURAL CONSIDERATIONS

CARER'S / PARENTS / GUARDIANS DETAILS

Our practice will work closely with other agencies to coordinate the best support for you. This means your informed consent for the sharing of information will be sought and respected in all situations unless:

  • we are obliged by law to disclose your information regardless of consent or otherwise.
  • it is unreasonable or impracticable to gain consent or consent has been refused; and
  • the disclosure is reasonably necessary to prevent or lessen a serious threat to the life, health, or safety of a person or group of people.
Do You Agree To The Terms & Conditions?
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Sunrise Behavioural Health acknowledges the Traditional Owners of Country throughout Australia and their continuing connection to the land and waterways. We pay our respects to Elders past, present and emerging, and acknowledge the strength and resilience of all Aboriginal and Torres Strait Islander people, families and communities.

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