Client Referral Form

Referral Criteria

Please note the following criteria before proceeding with a referral

• Adult aged 18+ who is a survivor of childhood sexual abuse OR
• Adult impacted by a disclosure of child sexual abuse such as a family member, friend, or significant other
• The person/s being referred reside within the Perth metropolitan area
• Signed consent from the person/s being referred is required to proceed
• This consent includes agreement for information sharing
• Any ongoing court matters must be disclosed
• Phoenix is not funded to provide crisis services, however, see website for crisis information
• Phoenix does not provide services for perpetrators or convicted offenders of child sexual abuse

PLEASE NOTE: The information sought in the referral form assists Phoenix to determine if the service is suitable and/or appropriate, and aims to minimise the referred person/s having to repeat information they have already disclosed where it is not necessary to do so.

Referring Agency Information - Step 1 of 7
Please tick the box with the main reason the individual / family is being referred
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Safety Online

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