headspace Armadale is a free, youth-friendly and confidential service available to young people aged 12 25 years, in the – south east metropolitan region of Perth. headspace Armadale brings together a range of co-located community-based and government agencies, to provide a holistic service as a young people. We offer information, intake, “one-stop-shop” for assessment and referral. The services available at headspace Armadale include: Youth Friendly General Practitioner/s Drug and alcohol outreach worker Youth Support Workers MBS & ATAPS Psychological services Sexual health clinic Vocational support worker How to refer Professional Referral Professionals, community-based agencies and educational institutions Referrals accepted from GP’s, Allied Health a copy of the Health Treatment Plan Where available, GP’s should include client’s Mental Self-referral By phone/ email: please call 08 9393 0300 or email (please note these are only attended/checked during business hours) Drop in: Young people can drop in to headspace Armadale between 9am and 5pm, Monday Friday. Staff will – endeavour to see the young person the same day or the next available appointment will be offered Family Referral Families, carers of friends can refer a young person to headspace Armadale. The young person needs to be aware of and consent to the referral and be willing to meet with a member of the headspace Armadale team Client Details Date of Referral DOB Age / / Name Gender Address Email Mobile Home Phone Medicare No. Reference No. Expiry Date: (nothing billed without prior consent): Are there any safety concerns when contacting the patient by phone/mail? Consent to contact young person via: (e.g. confirm appointments etc.) Mobile: Yes No Text: Yes No Voicemail: Yes No Email: Yes No Mail: Yes No At home: Yes No Preferred method of contact (this can change and other arrangements can be made): Language spoken at home? Ability to speak English? Preferred Language Very well Well Not well Not at all What is the cultural background? Aboriginal TSI Other Unknown client’s Who does the young person live with? Education/employment status? Is the client aware and consented to the referral and wanting treatment? Next of Kin (MUST be completed if client is under 16 unless mature minor process followed) Next of Kin name Mobile number Relationship to client Home number Is the young aware that this referral has been made? Yes No person’s parent/guardian
headspace Armadale is a free, youth-friendly and confidential service available to young people aged 12 – 25 years, in the south east metropolitan region of Perth. headspace Armadale brings together a range of co-located community-based and government agencies, to provide a holistic service as a “one-stop-shop” for young people. We offer information, intake, assessment and referral. The services available at headspace Armadale include: Youth Friendly General Practitioner/s Youth Support Workers Sexual health clinic Drug and alcohol outreach worker MBS & ATAPS Psychological services Vocational support worker How to refer Professional Referral Referrals accepted from GP’s, Allied Health Professionals, community-based agencies and educational institutions Where available, GP’s should include a copy of the client’s Mental Health Treatment Plan Self-referral By phone/ email: please call 08 9393 0300 or email (please note these are only attended/checked during business hours) Drop in: Young people can drop in to headspace Armadale between 9am and 5pm, Monday – Friday. Staff will endeavour to see the young person the same day or the next available appointment will be offered Family Referral Families, carers of friends can refer a young person to headspace Armadale. The young person needs to be aware of and consent to the referral and be willing to meet with a member of the headspace Armadale team Client Details Date of Referral DOB / / Age Name Gender Address Email Mobile Home Phone Medicare No. (nothing billed without prior consent): Reference No. Expiry Date: Are there any safety concerns when contacting the patient by phone/mail? Consent to contact young person via: (e.g. confirm appointments etc.) Mobile: Yes No Text: Yes No Voicemail: Yes No Email: Yes No Mail: Yes No At home: Yes No Preferred method of contact (this can change and other arrangements can be made): Language spoken at home? Ability to speak English? Very well Well Not well Not at all Preferred Language What is the client’s cultural background? Aboriginal TSI Other Unknown Who does the young person live with? Education/employment status? Is the client aware and consented to the referral and wanting treatment? Next of Kin (MUST be completed if client is under 16 unless mature minor process followed) Next of Kin name Mobile number Relationship to client Home number Is the young person’s parent/guardian aware that this referral has been made? Yes No
headspace-Armadale-Referral-Form-updated.docx