"Recovery isn’t about getting back to how you were before,
it's about building something new" Anonymous

Referral form

Referral

PART A: REFERRAL
PART A: INDIVIDUALS INFORMATION
PART B: ELIGIBILITY
Description of complex needs:
PART C: CURRENT SUPPORTS
PART D: CONSENT
PRIVACY NOTICE: Centacare FNQ as the Lead Agency for Far North Queensland Partners In Recovery (FNQ PIR) collects personal information contained within this referral form for the purpose of determining eligibility for the FNQ PIR Initiative. The information may be disclosed to the appointed Support Facilitator Agency. Additionally as part of the activity and reporting requirements de-identified personal information may be disclosed to the Department of Health. Unless required by another state and national authority for legal reasons, the personal information of the Client will not be passed on to any other third party without prior consent.
A referral outcome will be provided to the referring agency.