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Client Referral Form

Please complete the details below to refer your client. Please provide as much information as you can and I will be in touch with the key contact person listed soon.

Have you discussed this referral with the person requiring support and / or their carer and do they consent to the sharing of this information with Pause You Counselling for the purpose of receiving services?
Is this referral urgent
Is this person an NDIS Participant?

Thank you for referring.

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