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PATTS – Perth Adult and Teen Therapy Supports
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Referrals

Thank you for considering PATTS. Please fill out the form below to complete your referral.

Participant Details

Name(Required)
DOB(Required)
Address(Required)
Is another party legally appointed to make decisions for the participant?(Required)
Guardian Name(Required)

Referrers Details

Referrer Name(Required)
Do you have a support coordinator or LAC(Required)
Are you the preferred contact?(Required)
Preferred Contact Name(Required)

NDIS Plan details

How is your plan managed?(Required)

Referral Information

PATTS is a mobile only service. Is the client/referrer aware that travel will be charged from your NDIS plan?(Required)
Does the client/referrer consent to a phone call prior to services commencing to complete a risk assessment(Required)
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