Referral Form


Details of referred person - please use the young person’s full name

eEHA / Statutory assessment in place?

Reason for referral

Please provide information on the young person’s current situation and support needs with reference to the following areas.

General health, mental health, drugs & alcohol, education, aspirations
Describe the young person’s relationship with parents/carers
Does the young person consent to sharing information with parents about this referral?
Are parents/carers aware of this referral and the situation the young person is facing?
Family history, social & family relationships, well-being, housing, employment, financial situation

Details of referral agency


Has the young person named on this referral form consented to a referral to Spotlight and for information to be shared amongst Spotlight partners?

Consent has been obtained?
If No, is young person aware of the referral?