Get Recreation Service Referral Form - Northcott

Filling out the Recreation Service Referral Form - Northcott online is a straightforward process designed to help individuals access necessary recreational services. This guide will walk you through each section of the form, ensuring you provide all required information accurately and thoroughly.

Follow the steps to complete the online form effectively.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Begin by filling out the recreational service type you are applying for, selecting either 'Children’s Recreation – School Age' or 'Adult Recreation – Post School'.
3. Provide the individual's name along with their date of birth, email address, and phone numbers. Ensure you specify if the individual is under 18, in which case the parent/carer's name must be filled out.
4. Indicate whether the person is aware of the referral by checking 'Yes' or 'No'.
5. Detail the primary and secondary disabilities, including the age of onset of the primary disability.
6. Select the communication method by indicating if the individual is verbal, non-verbal, or if it is unknown. If non-verbal, specify how the person communicates.
7. Note if an interpreter is required and specify the language if applicable.
8. List any other Northcott services the client is involved in or additional service providers agency.
9. Describe the individual’s living situation. Indicate if they live alone, with family or friends, in supported accommodation, transitional accommodation, or specify other.
10. Assess mobility by selecting appropriate options, such as manual or electric wheelchair, walking assisted, or unassisted.
11. Determine if the client can manage their own wheelchair and indicate if they have any assessed needs that require recreational services.
12. List any medications taken by the client and their schedule. Confirm if they have epilepsy and provide details of any seizures.
13. Complete the medical needs section by checking any applicable medical conditions such as allergies, asthma, diabetes, etc.
14. Fill in the referrer information, including name, relationship to the client, address, and contact details.
15. Sign and date the form to confirm its accuracy and completeness.
16. After filling out the form, save your changes and choose to download, print, or share the form as needed.

Complete your Recreation Service Referral Form online today to ensure access to vital recreational services.