(02) 6248 8577

info@marss.org.au

Level 2, 180 London Circuit, Civic, ACT

REFERRAL

Service providers and agencies within the ACT can refer eligible clients to MARSS services. The referral process is for agencies and service providers only, if you are an individual who requires access to MARSS services, please come to the MARSS Office or contact MARSS.

 

To refer one of your eligible clients to MARSS, please complete the referral form below or attach the completed word version of the form in an email to MARSS reception.

REFERRING AGENCY
CLIENT INFORMATION
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SERVICE REQUESTED
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CONSENT TO RELEASE INFORMATION

Read with client/caregiver and answer any questions before obtaining signature. 

The signature below serves to authorise that the client understands that the purpose of the referral and disclosure of information to MARSS Australia Inc. to ensure the safety and continuity of care among service providers seeking to serve the client. The referring agency has clearly explained the procedure of the referral to the client and has listed the exact information that is to be disclosed. By signing this form, the client authorises this exchange of information.

Upload Caregiver Signature
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Upload Client Signature
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DETAILS OF REFERRAL
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