First, tell us more about yourselfReferrer's Name* Referrer's OrganisationReferrer's phone number*Referrer's Email What is your relationship to the person you are referring?*What is the best way to reach you? Please select all that apply Phone Email Text ADACAS supports people with disability, mental ill health, older persons, and carers. Do you identify as being a part of one or more of these groups? Yes No Which of these groups do you identify with? I am a person with disability I am a person with mental ill health I am an older person I am a carer Now tell us about the person you are referring. Do they know you are making this referral? Yes No Has the person given consent for this referral? Yes No ADACAS supports people with disability, mental ill health, older persons, carers and applicants to the National Redress Scheme. Does the person identify as being a part of one or more of these groups? Yes No ADACAS is only funded to support people with disability, mental ill-health, older persons, carer's and people making applications to the National Redress Scheme. If you are unsure if the person belongs to one of these groups please call us so we can direct you to a service who may be able to help the person. You can look for more information in our I want to help myself pages. I want to help myselfWhich of these groups does the person identify with? They are a person with disability They are a person with mental ill health They are an older person They are a carer They want to apply to the National Redress Scheme So we can better understand their situation, please tell us more about their disability or conditionCan you tell us some details about the person?Name* Date of Birth DD slash MM slash YYYY Age*Phone*Email Address (please include your suburb, postcode and State if you can)Region*Select RegionCanberraQueanbeyanGoulburnShoalhavenEurobodallaOtherWhat is the best way to reach the person? Please select all that apply Phone Email Text Does the person identify as: An Aboriginal and or Torres Strait Islander Person Having a culturally, ethnically and linguistically diverse background None of the above Prefer not to say Would they like an interpreter? Yes No What type of interpreter do they need?Does the person have others that help them with decisions such as a: Guardian Enduring Power of Attorney NDIS Support Coordinator None of the above Would the person like any of these people to know about this advocacy? Yes No What would the person like support with? NDIS Aged Care Child Protection Mental Health Housing Justice / Court / ACAT Redress Health Education Employment Discrimination and Complaints Other Δ
