Referal Type Parental ReferralProfessional Referral Referrer's Details Your name Your email address Your organisation Your contact number Child's Details Child's name Child's age Child's school Child's school year Child in OOHCNoYes Child's interests Is there anything else Deadly Descendants needs to be aware of in regards to this referral? Aboriginal or Torres Strait IslanderNoYes Parent's Details Parent's name Parent's contact number Parent's email Additional Details NDIS funding?NoYes NDIS number NDIS code for service NDIS coordinators email Is a service agreement required for the NDIS plan?NoYes Has there been prior Counselling?NoYes Is there a diagnosis?NoYes ASDADHDAnxietySuicidalFASDTrauma Referral reason Emotional LiteracyEmotional RegulationSocial SkillsIndividual CounsellingGroup WorkYoga TherapyLego-Based TherapyParent psycho educationOther * Please note an assessment is required before a child can begin group sessions with other children. The assessment determines whether Lego-based therapy would be suitable for a child/teen, where they are at developmentally and it allows the therapist to identify which lego-based group would be suitable based on their interests, temperament and likelihood of connecting with the peers of the program.Δ
