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Client Details:
First Name: Last Name:
State: Post Code:
Postal/Shipping Address:
Click if As Above
Post City:
State: Post Code:
Client Details:
DOB: Indigenous Status:
Gender: Country of Birth:
Living Arrangements: Child Protection Client Status:
Source Of Referral: Client Service Type:
Reason For Referral: Client Group:
Referral Date: dd/mm/yyyy Closed Date:
Counsellor: Reason for Closure:
Unprogressed: Drop-In:
Pre-School: Consent for Govt to Contact:
Highest Schooling: Receiving Centerlink?
Marital Status: Active?:
Who Received Service:  Client  Partner  Family  Friend  Parent/Carer
Phone: Mobile:
 Intellectual / Learning     None
 Not Stated / Inadequately Described     Other
 Physical / Diverse     Psychiatric
 Sensory / Speach 
Other Identified Issues:
 Aggressive Behaviours     Anger
 Anxiety     Attachment Disorder
 Bullying     Criminal Involvement
 Depression     Dissociation
 Domestic Violence     Drug / Alcohol Misuse
 Eating Disorder     Employment Problems
 Financial     Flashbacks
 Grief     Housing
 Interpersonal Relationships     Isolation
 Loneliness     Low Self-Esteem
 Mistrust     Nightmares
 Parenting Skills     Phobias
 Poor Impulse Control     Post - Trauma
 Problematic Sexual Behaviours     Revictimisation
 School Problems     Self Harming Behaviour
 Sexual Dysfunctions     Sexuality
 Sexually Abusive Behaviours     Sleep Disturbances
 Somatic Complaints     Suicidal Ideation / Behaviours
 Witness to Domestic Violence 
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Client Status:
 Improved Life Skills  Support Still Required
Therapeutic Interventions:

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Date: Tue, March 31, 2020 For: Recording Data Time: 5  Edit
Notes: Emailed Bronwyn to obtain DOB for Brieanna. LG

Date: Wed, March 25, 2020 For: Phone Contact Time: 5  Edit
Notes: Left a phone message for Natasha offering Protective Behaviours via long-distance. Asked her to call back to discuss. -BO.

Date: Tue, March 10, 2020 For: Writing Case Notes Time: 10  Edit
Notes: Breanna's case had been put on hold as Natasha had disengaged from the service. However, Bre (Williams) has now advised that she would now like to discuss enrolling Breanna in the Bumblebees program. -BO.

Date: Tue, March 10, 2020 For: Phone Contact Time: 5  Edit
Notes: Left a message inviting Natasha to call Phoenix House to schedule a new intake for Breanna - BO.

Date: Tue, January 14, 2020 For: Arranging Referrals Time: 15  Edit
Notes: This file assigned to Bronwyn. No appointment required from Admin. No recent entries. Original intake appnt missed. File to Bronwyn 14.01.2020. LG

Date: Thu, September 19, 2019 For: Phone Contact Time: 10  Edit
Notes: Called Natasha to follow up on a missed intake appointment today at 1:30 pm. Natasha has rescheduled the appointment for next Tuesday at 12:00 pm. - BO

Date: Tue, September 10, 2019 For: Arranging Referrals Time: 15  Edit
Notes: Update database and client spreadsheet and raise outside referral letter DBK

Date: Mon, September 9, 2019 For: Arranging Referrals Time: 15  Edit
Notes: Add to database and client spreadsheet ready for triage DBK

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Date: Mon, September 9, 2019 Action Reqired: No  Edit
Memo: IFS referral - Harding - Blossom Children.
Document:  View Document >>  

Date: Tue, September 10, 2019 Action Reqired: No  Edit
Memo: Outside referral letter - Harding Blossom
Document:  View Document >>  

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