Information sought in this form assists with determining if the services offered by Phoenix will be suitable for you.
I authorise Phoenix Support & Advocacy Service Inc. to exchange information with other relevant professionals or organisations.
This authority permits discussion between Phoenix and the parties mentioned below in addition to the exchange of written reports. This contact with other parties would be discussed with you prior, except in an emergency or if your safety and well-being are at risk.
I understand that I can change or cancel this authority at any time and can refuse to permit information exchange, except in the case of an emergency.
I understand that parties mentioned below will be provided with a copy of this authority before providing Phoenix with information.
Thank you for providing comprehensive information in this self-referral form.
Should you require further information or have any questions, please phone (08) 9443 1910 during business hours Tuesday, Wednesday or Thursday.
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