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Youth Assistance Programme Online Form

Section 1:  Your details

Let us get to know you a little.  Tell us some basic details about you

Now let us know how to best get back to you

How do you prefer to be contacted?
Section 2:  The Youth's Current Status

Please complete or check the appropriate responses regarding the above named young person

More Strengths
Health and Well Being
Behaviour (over and above usual adolescent changes)
Known Substances Used (or suspected to be used)
Section 3:  Some more details

If you are referring a young person please indicate if you:

Have discussed your concern with the young person
Have discussed your concern with a parent/caregiver
If you are the paent/caregiver, please select yes in this box to indiate you consent to this young person engaging with our service.
Would you like to speak with a Youth Health Support Service member regarding your concern?
Section 4:  Finishing up!

Thank you for your concern about our young people and your participation in the Youth Assistance Service process.  Abiding by the Code of Health & Disability Services Consumer Rights, all information will remain confidential.

We think we've got everything we need, but if we've missed something, please do let us know.  When you're satisfied there's nothing else to add, hit the submit button to get things underway

Supportive Documents - Upload File

Thanks for submitting! We will be in contact with you.

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