Get Referral Form - Starfish Social Services

Filling out the Referral Form for Starfish Social Services is a straightforward process that enables you to refer clients effectively. This guide provides step-by-step instructions to ensure that you complete each section accurately and provide the necessary information for a successful referral.

Follow the steps to complete the Referral Form accurately.

1. Press the ‘Get Form’ button to download the Referral Form and open it in your preferred document editor.
2. Begin with the Referrer Information section. Fill in your organization name, referral date, contact person's name, phone number, contact address, and fax number as applicable.
3. Move to the Client Information section. Enter the client's title, surname, given names, address, date of birth, ethnicity, and both daytime and after-hours phone numbers.
4. Indicate whether the client has consented to be contacted by letter, phone, and whether they agree to the referral by marking the appropriate options.
5. If available, include the client’s signature and date, along with your signature and date in the Referrer Signature section.
6. In the Information section, provide the reason for referral, client treatment goals, and assess their readiness to work on these goals by selecting one of the readiness options.
7. Detail current substance use, mental health history (past and current), whanau/family history, current medication, and any concerns regarding self-harm, harm to others, or suicide risk.
8. Address any justice issues by noting current charges, court name, and date. Add any additional comments that might assist in the referral process.
9. After completing all sections of the form, review to ensure accuracy and completeness. Save your changes.
10. Finally, you can choose to download, print, or share the completed form as needed.

Take a moment to complete the Referral Form online today.