hunterprimarycare.com.au
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urlscan Pro
101.0.70.86
Public Scan
Submitted URL: http://hunterpir.com.au/
Effective URL: https://hunterprimarycare.com.au/health-services/mental-health-services/hunter-psychosocial-support-service/
Submission: On March 29 via api from US — Scanned from DE
Effective URL: https://hunterprimarycare.com.au/health-services/mental-health-services/hunter-psychosocial-support-service/
Submission: On March 29 via api from US — Scanned from DE
Form analysis 5 forms found in the DOM
GET https://hunterprimarycare.com.au/
<form role="search" class="searchform fusion-search-form fusion-search-form-classic" method="get" action="https://hunterprimarycare.com.au/">
<div class="fusion-search-form-content">
<div class="fusion-search-field search-field">
<label><span class="screen-reader-text">Search for:</span>
<input type="search" value="" name="s" class="s" placeholder="Search..." required="" aria-required="true" aria-label="Search...">
</label>
</div>
<div class="fusion-search-button search-button">
<input type="submit" class="fusion-search-submit searchsubmit" aria-label="Search" value="">
</div>
</div>
</form>GET https://hunterprimarycare.com.au/
<form role="search" class="searchform fusion-search-form fusion-search-form-classic" method="get" action="https://hunterprimarycare.com.au/">
<div class="fusion-search-form-content">
<div class="fusion-search-field search-field">
<label><span class="screen-reader-text">Search for:</span>
<input type="search" value="" name="s" class="s" placeholder="Search..." required="" aria-required="true" aria-label="Search...">
</label>
</div>
<div class="fusion-search-button search-button">
<input type="submit" class="fusion-search-submit searchsubmit" aria-label="Search" value="">
</div>
</div>
</form>GET https://hunterprimarycare.com.au/
<form role="search" class="searchform fusion-search-form fusion-search-form-classic" method="get" action="https://hunterprimarycare.com.au/">
<div class="fusion-search-form-content">
<div class="fusion-search-field search-field">
<label><span class="screen-reader-text">Search for:</span>
<input type="search" value="" name="s" class="s" placeholder="Search..." required="" aria-required="true" aria-label="Search...">
</label>
</div>
<div class="fusion-search-button search-button">
<input type="submit" class="fusion-search-submit searchsubmit" aria-label="Search" value="">
</div>
</div>
</form>GET https://hunterprimarycare.com.au/
<form role="search" class="searchform fusion-search-form fusion-search-form-classic" method="get" action="https://hunterprimarycare.com.au/">
<div class="fusion-search-form-content">
<div class="fusion-search-field search-field">
<label><span class="screen-reader-text">Search for:</span>
<input type="search" value="" name="s" class="s" placeholder="Search..." required="" aria-required="true" aria-label="Search...">
</label>
</div>
<div class="fusion-search-button search-button">
<input type="submit" class="fusion-search-submit searchsubmit" aria-label="Search" value="">
</div>
</div>
</form><form>
<div>
<div class="nf-before-form-content"><nf-section>
<div class="nf-form-fields-required">Fields marked with an <span class="ninja-forms-req-symbol">*</span> are required</div>
</nf-section></div>
<div class="nf-form-content "><nf-rows-wrap>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-340-container" class="nf-field-container date-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-340-wrap" class="field-wrap date-wrap" data-field-id="340">
<div class="nf-field-label"><label for="nf-field-340" id="nf-label-field-340" class="">Referral Date </label></div>
<div class="nf-field-element">
<div class="pikaday__container"><!-- Pikaday mentions were added for backwards compatibility -->
<input id="nf-field-340" name="nf-field-340" aria-invalid="false" aria-describedby="nf-error-340" class="ninja-forms-field nf-element datepicker pikaday__display pikaday__display--pikaday flatpickr-input"
aria-labelledby="nf-label-field-340" type="hidden" value="29/03/2022"><input class="ninja-forms-field nf-element datepicker pikaday__display pikaday__display--pikaday form-control input" placeholder="" tabindex="0"
type="text">
</div>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-340" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-482-container" class="nf-field-container email-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-482-wrap" class="field-wrap email-wrap" data-field-id="482">
<div class="nf-field-label"><label for="nf-field-482" id="nf-label-field-482" class="">Email </label></div>
<div class="nf-field-element">
<input type="email" value="" class="ninja-forms-field nf-element" id="nf-field-482" name="email" autocomplete="email" aria-invalid="false" aria-describedby="nf-error-482" aria-labelledby="nf-label-field-482">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-482" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-394-container" class="nf-field-container listradio-container label-above two-col-list list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-394-wrap" class="field-wrap listradio-wrap list-wrap list-radio-wrap" data-field-id="394">
<div class="nf-field-label"><label for="nf-field-394" id="nf-label-field-394" class="">Is this referral for yourself? </label></div>
<div class="nf-field-element">
<ul aria-describedby="nf-error-394">
<li>
<input type="radio" id="nf-field-394-0" name="nf-field-394" class="ninja-forms-field nf-element " value="yes" aria-labelledby="nf-label-class-field-394-0">
<label for="nf-field-394-0" id="nf-label-class-field-394-0" class="">Yes</label>
</li>
<li>
<input type="radio" id="nf-field-394-1" name="nf-field-394" class="ninja-forms-field nf-element " value="no" aria-labelledby="nf-label-class-field-394-1">
<label for="nf-field-394-1" id="nf-label-class-field-394-1" class="">No</label>
</li>
</ul>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-394" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-452-container" class="nf-field-container hr-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-452-wrap" class="field-wrap hr-wrap" data-field-id="452">
<div class="nf-field-label"><label for="nf-field-452" id="nf-label-field-452" class="">Divider </label></div>
<div class="nf-field-element">
<hr class="ninja-forms-field">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-452" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-341-container" class="nf-field-container html-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-341-wrap" class="field-wrap html-wrap" data-field-id="341">
<div class="nf-field-label"><label for="nf-field-341" id="nf-label-field-341" class="">Person Information </label></div>
<div class="nf-field-element">
<h2>Person Information</h2>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-341" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-346-container" class="nf-field-container firstname-container label-above one-half first ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-346-wrap" class="field-wrap firstname-wrap" data-field-id="346">
<div class="nf-field-label"><label for="nf-field-346" id="nf-label-field-346" class="">First Name <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-346" name="fname" autocomplete="given-name" aria-invalid="false" aria-describedby="nf-error-346" aria-labelledby="nf-label-field-346" required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-346" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-345-container" class="nf-field-container lastname-container label-above one-half last ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-345-wrap" class="field-wrap lastname-wrap" data-field-id="345">
<div class="nf-field-label"><label for="nf-field-345" id="nf-label-field-345" class="">Last Name <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-345" name="lname" autocomplete="family-name" aria-invalid="false" aria-describedby="nf-error-345" aria-labelledby="nf-label-field-345"
required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-345" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-364-container" class="nf-field-container address-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-364-wrap" class="field-wrap address-wrap" data-field-id="364">
<div class="nf-field-label"><label for="nf-field-364" id="nf-label-field-364" class="">Street Address <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-364" name="address" autocomplete="address-line1" aria-invalid="false" aria-describedby="nf-error-364" aria-labelledby="nf-label-field-364"
required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-364" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-365-container" class="nf-field-container city-container label-above one-half first ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-365-wrap" class="field-wrap city-wrap" data-field-id="365">
<div class="nf-field-label"><label for="nf-field-365" id="nf-label-field-365" class="">Suburb <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-365" name="city" autocomplete="address-level2" aria-invalid="false" aria-describedby="nf-error-365" aria-labelledby="nf-label-field-365"
required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-365" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-366-container" class="nf-field-container zip-container label-above one-half last ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-366-wrap" class="field-wrap zip-wrap" data-field-id="366">
<div class="nf-field-label"><label for="nf-field-366" id="nf-label-field-366" class="">Postcode <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-366" name="zip" autocomplete="postal-code" aria-invalid="false" aria-describedby="nf-error-366" aria-labelledby="nf-label-field-366" required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-366" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-562-container" class="nf-field-container textbox-container label-above one-half first ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-562-wrap" class="field-wrap textbox-wrap" data-field-id="562">
<div class="nf-field-label"><label for="nf-field-562" id="nf-label-field-562" class="">Date of Birth <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-562" name="nf-field-562" aria-invalid="false" aria-describedby="nf-error-562" aria-labelledby="nf-label-field-562" required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-562" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-367-container" class="nf-field-container number-container label-above one-half last ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-367-wrap" class="field-wrap number-wrap" data-field-id="367">
<div class="nf-field-label"><label for="nf-field-367" id="nf-label-field-367" class="">Age <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<input id="nf-field-367" name="nf-field-367" aria-invalid="false" aria-describedby="nf-error-367" class="ninja-forms-field nf-element" aria-labelledby="nf-label-field-367" required="" type="number" value="" min="" max=""
step="1">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-367" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-368-container" class="nf-field-container phone-container label-above one-half first textbox-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-368-wrap" class="field-wrap phone-wrap textbox-wrap" data-field-id="368">
<div class="nf-field-label"><label for="nf-field-368" id="nf-label-field-368" class="">Mobile Phone <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<input type="tel" value="" class="ninja-forms-field nf-element" id="nf-field-368" name="phone" autocomplete="tel" aria-invalid="false" aria-describedby="nf-error-368" aria-labelledby="nf-label-field-368" required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-368" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-369-container" class="nf-field-container phone-container label-above one-half last textbox-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-369-wrap" class="field-wrap phone-wrap textbox-wrap" data-field-id="369">
<div class="nf-field-label"><label for="nf-field-369" id="nf-label-field-369" class="">Landline Phone </label></div>
<div class="nf-field-element">
<input type="tel" value="" class="ninja-forms-field nf-element" id="nf-field-369" name="phone" autocomplete="tel" aria-invalid="false" aria-describedby="nf-error-369" aria-labelledby="nf-label-field-369">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-369" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-370-container" class="nf-field-container email-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-370-wrap" class="field-wrap email-wrap" data-field-id="370">
<div class="nf-field-label"><label for="nf-field-370" id="nf-label-field-370" class="">Email </label></div>
<div class="nf-field-element">
<input type="email" value="" class="ninja-forms-field nf-element" id="nf-field-370" name="email" autocomplete="email" aria-invalid="false" aria-describedby="nf-error-370" aria-labelledby="nf-label-field-370">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-370" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-393-container" class="nf-field-container listradio-container label-above two-col-list list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-393-wrap" class="field-wrap listradio-wrap list-wrap list-radio-wrap" data-field-id="393">
<div class="nf-field-label"><label for="nf-field-393" id="nf-label-field-393" class="">Gender <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<ul aria-describedby="nf-error-393">
<li>
<input type="radio" id="nf-field-393-0" name="nf-field-393" class="ninja-forms-field nf-element " value="male" aria-labelledby="nf-label-class-field-393-0" required="">
<label for="nf-field-393-0" id="nf-label-class-field-393-0" class="">Male</label>
</li>
<li>
<input type="radio" id="nf-field-393-1" name="nf-field-393" class="ninja-forms-field nf-element " value="female" aria-labelledby="nf-label-class-field-393-1" required="">
<label for="nf-field-393-1" id="nf-label-class-field-393-1" class="">Female</label>
</li>
<li>
<input type="radio" id="nf-field-393-2" name="nf-field-393" class="ninja-forms-field nf-element " value="non-binary-gender-fluid" aria-labelledby="nf-label-class-field-393-2" required="">
<label for="nf-field-393-2" id="nf-label-class-field-393-2" class="">Non-Binary/Gender Fluid</label>
</li>
<li>
<input type="radio" id="nf-field-393-3" name="nf-field-393" class="ninja-forms-field nf-element " value="different-identity-please-specify-below" aria-labelledby="nf-label-class-field-393-3" required="">
<label for="nf-field-393-3" id="nf-label-class-field-393-3" class="">Different Identity (please specify below)</label>
</li>
</ul>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-393" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-356-container" class="nf-field-container textbox-container label-hidden ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-356-wrap" class="field-wrap textbox-wrap" data-field-id="356">
<div class="nf-field-label"><label for="nf-field-356" id="nf-label-field-356" class="">Other Response </label></div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-356" name="nf-field-356" aria-invalid="false" aria-describedby="nf-error-356" aria-labelledby="nf-label-field-356">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-356" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-387-container" class="nf-field-container listradio-container label-above two-col-list list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-387-wrap" class="field-wrap listradio-wrap list-wrap list-radio-wrap" data-field-id="387">
<div class="nf-field-label"><label for="nf-field-387" id="nf-label-field-387" class="">Identifies As <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<ul aria-describedby="nf-error-387">
<li>
<input type="radio" id="nf-field-387-0" name="nf-field-387" class="ninja-forms-field nf-element " value="aboriginal-but-not-torres-strait-islander" aria-labelledby="nf-label-class-field-387-0" required="">
<label for="nf-field-387-0" id="nf-label-class-field-387-0" class="">Aboriginal but NOT Torres Strait Islander</label>
</li>
<li>
<input type="radio" id="nf-field-387-1" name="nf-field-387" class="ninja-forms-field nf-element " value="both-aboriginal-and-torres-strait-islander" aria-labelledby="nf-label-class-field-387-1" required="">
<label for="nf-field-387-1" id="nf-label-class-field-387-1" class="">BOTH Aboriginal & Torres Strait Islander</label>
</li>
<li>
<input type="radio" id="nf-field-387-2" name="nf-field-387" class="ninja-forms-field nf-element " value="neither-aboriginal-or-torres-strait-islander" aria-labelledby="nf-label-class-field-387-2" required="">
<label for="nf-field-387-2" id="nf-label-class-field-387-2" class="">NEITHER Aboriginal or Torres Strait Islander</label>
</li>
<li>
<input type="radio" id="nf-field-387-3" name="nf-field-387" class="ninja-forms-field nf-element " value="torres-strait-islander-but-not-origin" aria-labelledby="nf-label-class-field-387-3" required="">
<label for="nf-field-387-3" id="nf-label-class-field-387-3" class="">Torres Strait Islander but NOT origin</label>
</li>
<li>
<input type="radio" id="nf-field-387-4" name="nf-field-387" class="ninja-forms-field nf-element " value="not-stated-adequately-described" aria-labelledby="nf-label-class-field-387-4" required="">
<label for="nf-field-387-4" id="nf-label-class-field-387-4" class="">NOT stated/adequately described</label>
</li>
</ul>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-387" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-371-container" class="nf-field-container textbox-container label-above one-half first ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-371-wrap" class="field-wrap textbox-wrap" data-field-id="371">
<div class="nf-field-label"><label for="nf-field-371" id="nf-label-field-371" class="">Mob or Country </label></div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-371" name="nf-field-371" aria-invalid="false" aria-describedby="nf-error-371" aria-labelledby="nf-label-field-371">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-371" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-372-container" class="nf-field-container textbox-container label-above one-half last ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-372-wrap" class="field-wrap textbox-wrap" data-field-id="372">
<div class="nf-field-label"><label for="nf-field-372" id="nf-label-field-372" class="">Country of Birth </label></div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-372" name="nf-field-372" aria-invalid="false" aria-describedby="nf-error-372" aria-labelledby="nf-label-field-372">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-372" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-373-container" class="nf-field-container listradio-container label-above two-col-list list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-373-wrap" class="field-wrap listradio-wrap list-wrap list-radio-wrap" data-field-id="373">
<div class="nf-field-label"><label for="nf-field-373" id="nf-label-field-373" class="">Is an Interpreter Required </label></div>
<div class="nf-field-element">
<ul aria-describedby="nf-error-373">
<li>
<input type="radio" id="nf-field-373-0" name="nf-field-373" class="ninja-forms-field nf-element " value="yes" aria-labelledby="nf-label-class-field-373-0">
<label for="nf-field-373-0" id="nf-label-class-field-373-0" class="">Yes</label>
</li>
<li>
<input type="radio" id="nf-field-373-1" name="nf-field-373" class="ninja-forms-field nf-element " value="no" aria-labelledby="nf-label-class-field-373-1">
<label for="nf-field-373-1" id="nf-label-class-field-373-1" class="">No</label>
</li>
</ul>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-373" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-375-container" class="nf-field-container listradio-container label-above two-col-list list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-375-wrap" class="field-wrap listradio-wrap list-wrap list-radio-wrap" data-field-id="375">
<div class="nf-field-label"><label for="nf-field-375" id="nf-label-field-375" class="">Resident of Australia </label></div>
<div class="nf-field-element">
<ul aria-describedby="nf-error-375">
<li>
<input type="radio" id="nf-field-375-0" name="nf-field-375" class="ninja-forms-field nf-element " value="yes" aria-labelledby="nf-label-class-field-375-0">
<label for="nf-field-375-0" id="nf-label-class-field-375-0" class="">Yes</label>
</li>
<li>
<input type="radio" id="nf-field-375-1" name="nf-field-375" class="ninja-forms-field nf-element " value="no" aria-labelledby="nf-label-class-field-375-1">
<label for="nf-field-375-1" id="nf-label-class-field-375-1" class="">No</label>
</li>
</ul>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-375" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-362-container" class="nf-field-container hr-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-362-wrap" class="field-wrap hr-wrap" data-field-id="362">
<div class="nf-field-label"><label for="nf-field-362" id="nf-label-field-362" class="">Divider </label></div>
<div class="nf-field-element">
<hr class="ninja-forms-field">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-362" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-376-container" class="nf-field-container listradio-container label-above two-col-list list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-376-wrap" class="field-wrap listradio-wrap list-wrap list-radio-wrap" data-field-id="376">
<div class="nf-field-label"><label for="nf-field-376" id="nf-label-field-376" class="">The person has a diagnosed mental illness that is severe in degree <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<ul aria-describedby="nf-error-376">
<li>
<input type="radio" id="nf-field-376-0" name="nf-field-376" class="ninja-forms-field nf-element " value="yes" aria-labelledby="nf-label-class-field-376-0" required="">
<label for="nf-field-376-0" id="nf-label-class-field-376-0" class="">Yes</label>
</li>
<li>
<input type="radio" id="nf-field-376-1" name="nf-field-376" class="ninja-forms-field nf-element " value="no" aria-labelledby="nf-label-class-field-376-1" required="">
<label for="nf-field-376-1" id="nf-label-class-field-376-1" class="">No</label>
</li>
</ul>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-376" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-363-container" class="nf-field-container listradio-container label-above two-col-list list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-363-wrap" class="field-wrap listradio-wrap list-wrap list-radio-wrap" data-field-id="363">
<div class="nf-field-label"><label for="nf-field-363" id="nf-label-field-363" class="">Is the person a participant of the NDIS? </label></div>
<div class="nf-field-element">
<ul aria-describedby="nf-error-363">
<li>
<input type="radio" id="nf-field-363-0" name="nf-field-363" class="ninja-forms-field nf-element " value="yes" aria-labelledby="nf-label-class-field-363-0">
<label for="nf-field-363-0" id="nf-label-class-field-363-0" class="">Yes</label>
</li>
<li>
<input type="radio" id="nf-field-363-1" name="nf-field-363" class="ninja-forms-field nf-element " value="no" aria-labelledby="nf-label-class-field-363-1">
<label for="nf-field-363-1" id="nf-label-class-field-363-1" class="">No</label>
</li>
</ul>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-363" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-358-container" class="nf-field-container listradio-container label-above two-col-list list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-358-wrap" class="field-wrap listradio-wrap list-wrap list-radio-wrap" data-field-id="358">
<div class="nf-field-label"><label for="nf-field-358" id="nf-label-field-358" class="">Is the person currently receiving support from NPS - Extension or Continuity of Supports? </label></div>
<div class="nf-field-element">
<ul aria-describedby="nf-error-358">
<li>
<input type="radio" id="nf-field-358-0" name="nf-field-358" class="ninja-forms-field nf-element " value="yes" aria-labelledby="nf-label-class-field-358-0">
<label for="nf-field-358-0" id="nf-label-class-field-358-0" class="">Yes</label>
</li>
<li>
<input type="radio" id="nf-field-358-1" name="nf-field-358" class="ninja-forms-field nf-element " value="no" aria-labelledby="nf-label-class-field-358-1">
<label for="nf-field-358-1" id="nf-label-class-field-358-1" class="">No</label>
</li>
</ul>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-358" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-357-container" class="nf-field-container listradio-container label-above two-col-list list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-357-wrap" class="field-wrap listradio-wrap list-wrap list-radio-wrap" data-field-id="357">
<div class="nf-field-label"><label for="nf-field-357" id="nf-label-field-357" class="">Is the person currently a client of Community Living Support (CLS) or Housing and Support Initiative (HASI)? </label></div>
<div class="nf-field-element">
<ul aria-describedby="nf-error-357">
<li>
<input type="radio" id="nf-field-357-0" name="nf-field-357" class="ninja-forms-field nf-element " value="yes" aria-labelledby="nf-label-class-field-357-0">
<label for="nf-field-357-0" id="nf-label-class-field-357-0" class="">Yes</label>
</li>
<li>
<input type="radio" id="nf-field-357-1" name="nf-field-357" class="ninja-forms-field nf-element " value="no" aria-labelledby="nf-label-class-field-357-1">
<label for="nf-field-357-1" id="nf-label-class-field-357-1" class="">No</label>
</li>
</ul>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-357" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-389-container" class="nf-field-container listcheckbox-container label-above two-col-list list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-389-wrap" class="field-wrap listcheckbox-wrap list-wrap list-checkbox-wrap" data-field-id="389">
<div class="nf-field-label"><label for="nf-field-389" id="nf-label-field-389" class="">What psychosocial areas are significantly impacted by their mental illness? (select all that apply) <span
class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<ul aria-describedby="nf-error-389">
<li>
<input type="checkbox" id="nf-field-389-0" name="nf-field-389" class="ninja-forms-field nf-element " value="social-skills-and-friendships" aria-labelledby="nf-label-field-389-0" required="">
<label for="nf-field-389-0" id="nf-label-field-389-0" class="">Social skills and friendships</label>
</li>
<li>
<input type="checkbox" id="nf-field-389-1" name="nf-field-389" class="ninja-forms-field nf-element " value="vocational-skills-and-goals" aria-labelledby="nf-label-field-389-1" required="">
<label for="nf-field-389-1" id="nf-label-field-389-1" class="">Vocational skills and goals</label>
</li>
<li>
<input type="checkbox" id="nf-field-389-2" name="nf-field-389" class="ninja-forms-field nf-element " value="education-and-training" aria-labelledby="nf-label-field-389-2" required="">
<label for="nf-field-389-2" id="nf-label-field-389-2" class="">Education and training</label>
</li>
<li>
<input type="checkbox" id="nf-field-389-3" name="nf-field-389" class="ninja-forms-field nf-element " value="maintaining-physical-wellbeing" aria-labelledby="nf-label-field-389-3" required="">
<label for="nf-field-389-3" id="nf-label-field-389-3" class="">Maintaining physical wellbeing</label>
</li>
<li>
<input type="checkbox" id="nf-field-389-4" name="nf-field-389" class="ninja-forms-field nf-element " value="daily-living-needs" aria-labelledby="nf-label-field-389-4" required="">
<label for="nf-field-389-4" id="nf-label-field-389-4" class="">Daily living needs</label>
</li>
<li>
<input type="checkbox" id="nf-field-389-5" name="nf-field-389" class="ninja-forms-field nf-element " value="building-broader-life-skills" aria-labelledby="nf-label-field-389-5" required="">
<label for="nf-field-389-5" id="nf-label-field-389-5" class="">Building broader life skills</label>
</li>
<li>
<input type="checkbox" id="nf-field-389-6" name="nf-field-389" class="ninja-forms-field nf-element " value="family-connections" aria-labelledby="nf-label-field-389-6" required="">
<label for="nf-field-389-6" id="nf-label-field-389-6" class="">Family connections</label>
</li>
<li>
<input type="checkbox" id="nf-field-389-7" name="nf-field-389" class="ninja-forms-field nf-element " value="financial-management-and-budgeting" aria-labelledby="nf-label-field-389-7" required="">
<label for="nf-field-389-7" id="nf-label-field-389-7" class="">Financial management and budgeting</label>
</li>
<li>
<input type="checkbox" id="nf-field-389-8" name="nf-field-389" class="ninja-forms-field nf-element " value="finding-and-managing-a-home" aria-labelledby="nf-label-field-389-8" required="">
<label for="nf-field-389-8" id="nf-label-field-389-8" class="">Finding and managing a home</label>
</li>
<li>
<input type="checkbox" id="nf-field-389-9" name="nf-field-389" class="ninja-forms-field nf-element " value="managing-drug-and-alcohol-addiction-including-tobacco" aria-labelledby="nf-label-field-389-9" required="">
<label for="nf-field-389-9" id="nf-label-field-389-9" class="">Managing drug and alcohol addiction, including tobacco</label>
</li>
</ul>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-389" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-360-container" class="nf-field-container listradio-container label-above two-col-list list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-360-wrap" class="field-wrap listradio-wrap list-wrap list-radio-wrap" data-field-id="360">
<div class="nf-field-label"><label for="nf-field-360" id="nf-label-field-360" class="">Does the person have barriers to engaging with services at this time? </label></div>
<div class="nf-field-element">
<ul aria-describedby="nf-error-360">
<li>
<input type="radio" id="nf-field-360-0" name="nf-field-360" class="ninja-forms-field nf-element " value="yes" aria-labelledby="nf-label-class-field-360-0">
<label for="nf-field-360-0" id="nf-label-class-field-360-0" class="">Yes</label>
</li>
<li>
<input type="radio" id="nf-field-360-1" name="nf-field-360" class="ninja-forms-field nf-element " value="no" aria-labelledby="nf-label-class-field-360-1">
<label for="nf-field-360-1" id="nf-label-class-field-360-1" class="">No</label>
</li>
</ul>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-360" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-352-container" class="nf-field-container listradio-container label-above two-col-list list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-352-wrap" class="field-wrap listradio-wrap list-wrap list-radio-wrap" data-field-id="352">
<div class="nf-field-label"><label for="nf-field-352" id="nf-label-field-352" class="">Person (or Guardian) has consented to be involved with HPSS <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<ul aria-describedby="nf-error-352">
<li>
<input type="radio" id="nf-field-352-0" name="nf-field-352" class="ninja-forms-field nf-element " value="yes" aria-labelledby="nf-label-class-field-352-0" required="">
<label for="nf-field-352-0" id="nf-label-class-field-352-0" class="">Yes</label>
</li>
<li>
<input type="radio" id="nf-field-352-1" name="nf-field-352" class="ninja-forms-field nf-element " value="no" aria-labelledby="nf-label-class-field-352-1" required="">
<label for="nf-field-352-1" id="nf-label-class-field-352-1" class="">No</label>
</li>
</ul>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-352" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-454-container" class="nf-field-container textarea-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-454-wrap" class="field-wrap textarea-wrap" data-field-id="454">
<div class="nf-field-label"><label for="nf-field-454" id="nf-label-field-454" class="">How would the person benefit from a referral to HPSS? <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<textarea id="nf-field-454" name="nf-field-454" aria-invalid="false" aria-describedby="nf-error-454" class="ninja-forms-field nf-element" aria-labelledby="nf-label-field-454" required=""></textarea>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-454" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-585-container" class="nf-field-container listradio-container label-above two-col-list list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-585-wrap" class="field-wrap listradio-wrap list-wrap list-radio-wrap" data-field-id="585">
<div class="nf-field-label"><label for="nf-field-585" id="nf-label-field-585" class="">Is the person in hospital at the time of referral? </label></div>
<div class="nf-field-element">
<ul aria-describedby="nf-error-585">
<li>
<input type="radio" id="nf-field-585-0" name="nf-field-585" class="ninja-forms-field nf-element " value="yes" aria-labelledby="nf-label-class-field-585-0">
<label for="nf-field-585-0" id="nf-label-class-field-585-0" class="">Yes</label>
</li>
<li>
<input type="radio" id="nf-field-585-1" name="nf-field-585" class="ninja-forms-field nf-element " value="no" aria-labelledby="nf-label-class-field-585-1">
<label for="nf-field-585-1" id="nf-label-class-field-585-1" class="">No</label>
</li>
</ul>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-585" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-361-container" class="nf-field-container hr-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-361-wrap" class="field-wrap hr-wrap" data-field-id="361">
<div class="nf-field-label"><label for="nf-field-361" id="nf-label-field-361" class="">Divider </label></div>
<div class="nf-field-element">
<hr class="ninja-forms-field">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-361" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-351-container" class="nf-field-container html-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-351-wrap" class="field-wrap html-wrap" data-field-id="351">
<div class="nf-field-label"><label for="nf-field-351" id="nf-label-field-351" class="">Referrer's Details </label></div>
<div class="nf-field-element">
<h2 style="text-align: left;">Referrer's Details</h2>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-351" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-350-container" class="nf-field-container textbox-container label-above one-half first ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-350-wrap" class="field-wrap textbox-wrap" data-field-id="350">
<div class="nf-field-label"><label for="nf-field-350" id="nf-label-field-350" class="">Name </label></div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-350" name="nf-field-350" aria-invalid="false" aria-describedby="nf-error-350" aria-labelledby="nf-label-field-350">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-350" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-349-container" class="nf-field-container textbox-container label-above one-half last ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-349-wrap" class="field-wrap textbox-wrap" data-field-id="349">
<div class="nf-field-label"><label for="nf-field-349" id="nf-label-field-349" class="">Organisation </label></div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-349" name="nf-field-349" aria-invalid="false" aria-describedby="nf-error-349" aria-labelledby="nf-label-field-349">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-349" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-344-container" class="nf-field-container address-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-344-wrap" class="field-wrap address-wrap" data-field-id="344">
<div class="nf-field-label"><label for="nf-field-344" id="nf-label-field-344" class="">Street Address </label></div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-344" name="address" autocomplete="address-line1" aria-invalid="false" aria-describedby="nf-error-344" aria-labelledby="nf-label-field-344">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-344" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-342-container" class="nf-field-container city-container label-above one-half first ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-342-wrap" class="field-wrap city-wrap" data-field-id="342">
<div class="nf-field-label"><label for="nf-field-342" id="nf-label-field-342" class="">Suburb </label></div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-342" name="city" autocomplete="address-level2" aria-invalid="false" aria-describedby="nf-error-342" aria-labelledby="nf-label-field-342">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-342" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-343-container" class="nf-field-container zip-container label-above one-half last ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-343-wrap" class="field-wrap zip-wrap" data-field-id="343">
<div class="nf-field-label"><label for="nf-field-343" id="nf-label-field-343" class="">Postcode </label></div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-343" name="zip" autocomplete="postal-code" aria-invalid="false" aria-describedby="nf-error-343" aria-labelledby="nf-label-field-343">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-343" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-339-container" class="nf-field-container phone-container label-above one-half first textbox-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-339-wrap" class="field-wrap phone-wrap textbox-wrap" data-field-id="339">
<div class="nf-field-label"><label for="nf-field-339" id="nf-label-field-339" class="">Direct Phone </label></div>
<div class="nf-field-element">
<input type="tel" value="" class="ninja-forms-field nf-element" id="nf-field-339" name="phone" autocomplete="tel" aria-invalid="false" aria-describedby="nf-error-339" aria-labelledby="nf-label-field-339">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-339" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-337-container" class="nf-field-container phone-container label-above one-half last textbox-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-337-wrap" class="field-wrap phone-wrap textbox-wrap" data-field-id="337">
<div class="nf-field-label"><label for="nf-field-337" id="nf-label-field-337" class="">Mobile Phone </label></div>
<div class="nf-field-element">
<input type="tel" value="" class="ninja-forms-field nf-element" id="nf-field-337" name="phone" autocomplete="tel" aria-invalid="false" aria-describedby="nf-error-337" aria-labelledby="nf-label-field-337">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-337" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-336-container" class="nf-field-container email-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-336-wrap" class="field-wrap email-wrap" data-field-id="336">
<div class="nf-field-label"><label for="nf-field-336" id="nf-label-field-336" class="">Email </label></div>
<div class="nf-field-element">
<input type="email" value="" class="ninja-forms-field nf-element" id="nf-field-336" name="email" autocomplete="email" aria-invalid="false" aria-describedby="nf-error-336" aria-labelledby="nf-label-field-336">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-336" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-377-container" class="nf-field-container textbox-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-377-wrap" class="field-wrap textbox-wrap" data-field-id="377">
<div class="nf-field-label"><label for="nf-field-377" id="nf-label-field-377" class="">Referrer Type (eg. self, GP, Social Worker etc.) </label></div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-377" name="nf-field-377" aria-invalid="false" aria-describedby="nf-error-377" aria-labelledby="nf-label-field-377">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-377" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-392-container" class="nf-field-container textarea-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-392-wrap" class="field-wrap textarea-wrap" data-field-id="392">
<div class="nf-field-label"><label for="nf-field-392" id="nf-label-field-392" class="">Recent history of service engagement </label></div>
<div class="nf-field-element">
<textarea id="nf-field-392" name="nf-field-392" aria-invalid="false" aria-describedby="nf-error-392" class="ninja-forms-field nf-element" aria-labelledby="nf-label-field-392"></textarea>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-392" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-391-container" class="nf-field-container textarea-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-391-wrap" class="field-wrap textarea-wrap" data-field-id="391">
<div class="nf-field-label"><label for="nf-field-391" id="nf-label-field-391" class="">Other services person is currently linked with (100 word limit) </label></div>
<div class="nf-field-element">
<textarea id="nf-field-391" name="nf-field-391" aria-invalid="false" aria-describedby="nf-error-391" class="ninja-forms-field nf-element" aria-labelledby="nf-label-field-391"></textarea>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"> 100 of 100 Character(s) left </div>
<div id="nf-error-391" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-378-container" class="nf-field-container hr-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-378-wrap" class="field-wrap hr-wrap" data-field-id="378">
<div class="nf-field-label"><label for="nf-field-378" id="nf-label-field-378" class="">Divider </label></div>
<div class="nf-field-element">
<hr class="ninja-forms-field">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-378" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-379-container" class="nf-field-container listradio-container label-above four-col-list list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-379-wrap" class="field-wrap listradio-wrap list-wrap list-radio-wrap" data-field-id="379">
<div class="nf-field-label"><label for="nf-field-379" id="nf-label-field-379" class="">Apparent co-existing factors that impact on mental illness </label></div>
<div class="nf-field-element">
<ul aria-describedby="nf-error-379">
<li>
<input type="radio" id="nf-field-379-0" name="nf-field-379" class="ninja-forms-field nf-element " value="no" aria-labelledby="nf-label-class-field-379-0">
<label for="nf-field-379-0" id="nf-label-class-field-379-0" class="">No</label>
</li>
<li>
<input type="radio" id="nf-field-379-1" name="nf-field-379" class="ninja-forms-field nf-element " value="not-reported" aria-labelledby="nf-label-class-field-379-1">
<label for="nf-field-379-1" id="nf-label-class-field-379-1" class="">Not Reported</label>
</li>
<li>
<input type="radio" id="nf-field-379-2" name="nf-field-379" class="ninja-forms-field nf-element " value="unknown" aria-labelledby="nf-label-class-field-379-2">
<label for="nf-field-379-2" id="nf-label-class-field-379-2" class="">Unknown</label>
</li>
<li>
<input type="radio" id="nf-field-379-3" name="nf-field-379" class="ninja-forms-field nf-element " value="yes" aria-labelledby="nf-label-class-field-379-3">
<label for="nf-field-379-3" id="nf-label-class-field-379-3" class="">Yes</label>
</li>
</ul>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-379" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-380-container" class="nf-field-container listradio-container label-above four-col-list list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-380-wrap" class="field-wrap listradio-wrap list-wrap list-radio-wrap" data-field-id="380">
<div class="nf-field-label"><label for="nf-field-380" id="nf-label-field-380" class="">Drug or Alcohol Abuse </label></div>
<div class="nf-field-element">
<ul aria-describedby="nf-error-380">
<li>
<input type="radio" id="nf-field-380-0" name="nf-field-380" class="ninja-forms-field nf-element " value="no" aria-labelledby="nf-label-class-field-380-0">
<label for="nf-field-380-0" id="nf-label-class-field-380-0" class="">No</label>
</li>
<li>
<input type="radio" id="nf-field-380-1" name="nf-field-380" class="ninja-forms-field nf-element " value="not-reported" aria-labelledby="nf-label-class-field-380-1">
<label for="nf-field-380-1" id="nf-label-class-field-380-1" class="">Not Reported</label>
</li>
<li>
<input type="radio" id="nf-field-380-2" name="nf-field-380" class="ninja-forms-field nf-element " value="unknown" aria-labelledby="nf-label-class-field-380-2">
<label for="nf-field-380-2" id="nf-label-class-field-380-2" class="">Unknown</label>
</li>
<li>
<input type="radio" id="nf-field-380-3" name="nf-field-380" class="ninja-forms-field nf-element " value="yes" aria-labelledby="nf-label-class-field-380-3">
<label for="nf-field-380-3" id="nf-label-class-field-380-3" class="">Yes</label>
</li>
</ul>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-380" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-381-container" class="nf-field-container listradio-container label-above four-col-list list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-381-wrap" class="field-wrap listradio-wrap list-wrap list-radio-wrap" data-field-id="381">
<div class="nf-field-label"><label for="nf-field-381" id="nf-label-field-381" class="">Intellectual / Cognitive Disability </label></div>
<div class="nf-field-element">
<ul aria-describedby="nf-error-381">
<li>
<input type="radio" id="nf-field-381-0" name="nf-field-381" class="ninja-forms-field nf-element " value="no" aria-labelledby="nf-label-class-field-381-0">
<label for="nf-field-381-0" id="nf-label-class-field-381-0" class="">No</label>
</li>
<li>
<input type="radio" id="nf-field-381-1" name="nf-field-381" class="ninja-forms-field nf-element " value="not-reported" aria-labelledby="nf-label-class-field-381-1">
<label for="nf-field-381-1" id="nf-label-class-field-381-1" class="">Not Reported</label>
</li>
<li>
<input type="radio" id="nf-field-381-2" name="nf-field-381" class="ninja-forms-field nf-element " value="unknown" aria-labelledby="nf-label-class-field-381-2">
<label for="nf-field-381-2" id="nf-label-class-field-381-2" class="">Unknown</label>
</li>
<li>
<input type="radio" id="nf-field-381-3" name="nf-field-381" class="ninja-forms-field nf-element " value="yes" aria-labelledby="nf-label-class-field-381-3">
<label for="nf-field-381-3" id="nf-label-class-field-381-3" class="">Yes</label>
</li>
</ul>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-381" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-382-container" class="nf-field-container listradio-container label-above four-col-list list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-382-wrap" class="field-wrap listradio-wrap list-wrap list-radio-wrap" data-field-id="382">
<div class="nf-field-label"><label for="nf-field-382" id="nf-label-field-382" class="">Physical Disability </label></div>
<div class="nf-field-element">
<ul aria-describedby="nf-error-382">
<li>
<input type="radio" id="nf-field-382-0" name="nf-field-382" class="ninja-forms-field nf-element " value="no" aria-labelledby="nf-label-class-field-382-0">
<label for="nf-field-382-0" id="nf-label-class-field-382-0" class="">No</label>
</li>
<li>
<input type="radio" id="nf-field-382-1" name="nf-field-382" class="ninja-forms-field nf-element " value="not-reported" aria-labelledby="nf-label-class-field-382-1">
<label for="nf-field-382-1" id="nf-label-class-field-382-1" class="">Not Reported</label>
</li>
<li>
<input type="radio" id="nf-field-382-2" name="nf-field-382" class="ninja-forms-field nf-element " value="unknown" aria-labelledby="nf-label-class-field-382-2">
<label for="nf-field-382-2" id="nf-label-class-field-382-2" class="">Unknown</label>
</li>
<li>
<input type="radio" id="nf-field-382-3" name="nf-field-382" class="ninja-forms-field nf-element " value="yes" aria-labelledby="nf-label-class-field-382-3">
<label for="nf-field-382-3" id="nf-label-class-field-382-3" class="">Yes</label>
</li>
</ul>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-382" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-383-container" class="nf-field-container listradio-container label-above four-col-list list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-383-wrap" class="field-wrap listradio-wrap list-wrap list-radio-wrap" data-field-id="383">
<div class="nf-field-label"><label for="nf-field-383" id="nf-label-field-383" class="">Sensory or Speech </label></div>
<div class="nf-field-element">
<ul aria-describedby="nf-error-383">
<li>
<input type="radio" id="nf-field-383-0" name="nf-field-383" class="ninja-forms-field nf-element " value="no" aria-labelledby="nf-label-class-field-383-0">
<label for="nf-field-383-0" id="nf-label-class-field-383-0" class="">No</label>
</li>
<li>
<input type="radio" id="nf-field-383-1" name="nf-field-383" class="ninja-forms-field nf-element " value="not-reported" aria-labelledby="nf-label-class-field-383-1">
<label for="nf-field-383-1" id="nf-label-class-field-383-1" class="">Not Reported</label>
</li>
<li>
<input type="radio" id="nf-field-383-2" name="nf-field-383" class="ninja-forms-field nf-element " value="unknown" aria-labelledby="nf-label-class-field-383-2">
<label for="nf-field-383-2" id="nf-label-class-field-383-2" class="">Unknown</label>
</li>
<li>
<input type="radio" id="nf-field-383-3" name="nf-field-383" class="ninja-forms-field nf-element " value="yes" aria-labelledby="nf-label-class-field-383-3">
<label for="nf-field-383-3" id="nf-label-class-field-383-3" class="">Yes</label>
</li>
</ul>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-383" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-384-container" class="nf-field-container listradio-container label-above four-col-list list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-384-wrap" class="field-wrap listradio-wrap list-wrap list-radio-wrap" data-field-id="384">
<div class="nf-field-label"><label for="nf-field-384" id="nf-label-field-384" class="">Significant Physical Issues </label></div>
<div class="nf-field-element">
<ul aria-describedby="nf-error-384">
<li>
<input type="radio" id="nf-field-384-0" name="nf-field-384" class="ninja-forms-field nf-element " value="no" aria-labelledby="nf-label-class-field-384-0">
<label for="nf-field-384-0" id="nf-label-class-field-384-0" class="">No</label>
</li>
<li>
<input type="radio" id="nf-field-384-1" name="nf-field-384" class="ninja-forms-field nf-element " value="not-reported" aria-labelledby="nf-label-class-field-384-1">
<label for="nf-field-384-1" id="nf-label-class-field-384-1" class="">Not Reported</label>
</li>
<li>
<input type="radio" id="nf-field-384-2" name="nf-field-384" class="ninja-forms-field nf-element " value="unknown" aria-labelledby="nf-label-class-field-384-2">
<label for="nf-field-384-2" id="nf-label-class-field-384-2" class="">Unknown</label>
</li>
<li>
<input type="radio" id="nf-field-384-3" name="nf-field-384" class="ninja-forms-field nf-element " value="yes" aria-labelledby="nf-label-class-field-384-3">
<label for="nf-field-384-3" id="nf-label-class-field-384-3" class="">Yes</label>
</li>
</ul>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-384" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-385-container" class="nf-field-container listradio-container label-above four-col-list list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-385-wrap" class="field-wrap listradio-wrap list-wrap list-radio-wrap" data-field-id="385">
<div class="nf-field-label"><label for="nf-field-385" id="nf-label-field-385" class="">Acquired Brain Injury </label></div>
<div class="nf-field-element">
<ul aria-describedby="nf-error-385">
<li>
<input type="radio" id="nf-field-385-0" name="nf-field-385" class="ninja-forms-field nf-element " value="no" aria-labelledby="nf-label-class-field-385-0">
<label for="nf-field-385-0" id="nf-label-class-field-385-0" class="">No</label>
</li>
<li>
<input type="radio" id="nf-field-385-1" name="nf-field-385" class="ninja-forms-field nf-element " value="not-reported" aria-labelledby="nf-label-class-field-385-1">
<label for="nf-field-385-1" id="nf-label-class-field-385-1" class="">Not Reported</label>
</li>
<li>
<input type="radio" id="nf-field-385-2" name="nf-field-385" class="ninja-forms-field nf-element " value="unknown" aria-labelledby="nf-label-class-field-385-2">
<label for="nf-field-385-2" id="nf-label-class-field-385-2" class="">Unknown</label>
</li>
<li>
<input type="radio" id="nf-field-385-3" name="nf-field-385" class="ninja-forms-field nf-element " value="yes" aria-labelledby="nf-label-class-field-385-3">
<label for="nf-field-385-3" id="nf-label-class-field-385-3" class="">Yes</label>
</li>
</ul>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-385" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-386-container" class="nf-field-container listradio-container label-above four-col-list list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-386-wrap" class="field-wrap listradio-wrap list-wrap list-radio-wrap" data-field-id="386">
<div class="nf-field-label"><label for="nf-field-386" id="nf-label-field-386" class="">Dementia </label></div>
<div class="nf-field-element">
<ul aria-describedby="nf-error-386">
<li>
<input type="radio" id="nf-field-386-0" name="nf-field-386" class="ninja-forms-field nf-element " value="no" aria-labelledby="nf-label-class-field-386-0">
<label for="nf-field-386-0" id="nf-label-class-field-386-0" class="">No</label>
</li>
<li>
<input type="radio" id="nf-field-386-1" name="nf-field-386" class="ninja-forms-field nf-element " value="not-reported" aria-labelledby="nf-label-class-field-386-1">
<label for="nf-field-386-1" id="nf-label-class-field-386-1" class="">Not Reported</label>
</li>
<li>
<input type="radio" id="nf-field-386-2" name="nf-field-386" class="ninja-forms-field nf-element " value="unknown" aria-labelledby="nf-label-class-field-386-2">
<label for="nf-field-386-2" id="nf-label-class-field-386-2" class="">Unknown</label>
</li>
<li>
<input type="radio" id="nf-field-386-3" name="nf-field-386" class="ninja-forms-field nf-element " value="yes" aria-labelledby="nf-label-class-field-386-3">
<label for="nf-field-386-3" id="nf-label-class-field-386-3" class="">Yes</label>
</li>
</ul>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-386" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-388-container" class="nf-field-container listcheckbox-container label-above three-col-list list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-388-wrap" class="field-wrap listcheckbox-wrap list-wrap list-checkbox-wrap" data-field-id="388">
<div class="nf-field-label"><label for="nf-field-388" id="nf-label-field-388" class="">ALERTS OR RISKS WE NEED TO BE AWARE OF <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<ul aria-describedby="nf-error-388">
<li>
<input type="checkbox" id="nf-field-388-0" name="nf-field-388" class="ninja-forms-field nf-element " value="vicious-animal-s" aria-labelledby="nf-label-field-388-0" required="">
<label for="nf-field-388-0" id="nf-label-field-388-0" class="">Vicious Animal/s</label>
</li>
<li>
<input type="checkbox" id="nf-field-388-1" name="nf-field-388" class="ninja-forms-field nf-element " value="firearms-weapons" aria-labelledby="nf-label-field-388-1" required="">
<label for="nf-field-388-1" id="nf-label-field-388-1" class="">Firearms/Weapons</label>
</li>
<li>
<input type="checkbox" id="nf-field-388-2" name="nf-field-388" class="ninja-forms-field nf-element " value="self-harm" aria-labelledby="nf-label-field-388-2" required="">
<label for="nf-field-388-2" id="nf-label-field-388-2" class="">Self Harm</label>
</li>
<li>
<input type="checkbox" id="nf-field-388-3" name="nf-field-388" class="ninja-forms-field nf-element " value="suicidal-ideation" aria-labelledby="nf-label-field-388-3" required="">
<label for="nf-field-388-3" id="nf-label-field-388-3" class="">Suicidal Ideation</label>
</li>
<li>
<input type="checkbox" id="nf-field-388-4" name="nf-field-388" class="ninja-forms-field nf-element " value="domestic-violence" aria-labelledby="nf-label-field-388-4" required="">
<label for="nf-field-388-4" id="nf-label-field-388-4" class="">Domestic Violence</label>
</li>
<li>
<input type="checkbox" id="nf-field-388-5" name="nf-field-388" class="ninja-forms-field nf-element " value="harm-to-others" aria-labelledby="nf-label-field-388-5" required="">
<label for="nf-field-388-5" id="nf-label-field-388-5" class="">Harm to Others</label>
</li>
<li>
<input type="checkbox" id="nf-field-388-6" name="nf-field-388" class="ninja-forms-field nf-element " value="house-in-poor-condition" aria-labelledby="nf-label-field-388-6" required="">
<label for="nf-field-388-6" id="nf-label-field-388-6" class="">House in Poor Condition</label>
</li>
<li>
<input type="checkbox" id="nf-field-388-7" name="nf-field-388" class="ninja-forms-field nf-element " value="no-risks-identified" aria-labelledby="nf-label-field-388-7" required="">
<label for="nf-field-388-7" id="nf-label-field-388-7" class="">No Risks Identified</label>
</li>
</ul>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-388" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-390-container" class="nf-field-container hr-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-390-wrap" class="field-wrap hr-wrap" data-field-id="390">
<div class="nf-field-label"><label for="nf-field-390" id="nf-label-field-390" class="">Divider </label></div>
<div class="nf-field-element">
<hr class="ninja-forms-field">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-390" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-353-container" class="nf-field-container listcheckbox-container label-above two-col-list list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-353-wrap" class="field-wrap listcheckbox-wrap list-wrap list-checkbox-wrap" data-field-id="353">
<div class="nf-field-label"><label for="nf-field-353" id="nf-label-field-353" class="">Where did you hear about Hunter Primary Care HPSS Support? <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<ul aria-describedby="nf-error-353">
<li>
<input type="checkbox" id="nf-field-353-0" name="nf-field-353" class="ninja-forms-field nf-element " value="social-media" aria-labelledby="nf-label-field-353-0" required="">
<label for="nf-field-353-0" id="nf-label-field-353-0" class="">Social Media</label>
</li>
<li>
<input type="checkbox" id="nf-field-353-1" name="nf-field-353" class="ninja-forms-field nf-element " value="referral" aria-labelledby="nf-label-field-353-1" required="">
<label for="nf-field-353-1" id="nf-label-field-353-1" class="">Referral</label>
</li>
<li>
<input type="checkbox" id="nf-field-353-2" name="nf-field-353" class="ninja-forms-field nf-element " value="internet-search" aria-labelledby="nf-label-field-353-2" required="">
<label for="nf-field-353-2" id="nf-label-field-353-2" class="">Internet Search</label>
</li>
<li>
<input type="checkbox" id="nf-field-353-3" name="nf-field-353" class="ninja-forms-field nf-element " value="gp-waiting-room" aria-labelledby="nf-label-field-353-3" required="">
<label for="nf-field-353-3" id="nf-label-field-353-3" class="">GP Waiting Room</label>
</li>
<li>
<input type="checkbox" id="nf-field-353-4" name="nf-field-353" class="ninja-forms-field nf-element " value="digital-online" aria-labelledby="nf-label-field-353-4" required="">
<label for="nf-field-353-4" id="nf-label-field-353-4" class="">Digital/Online Advertising</label>
</li>
<li>
<input type="checkbox" id="nf-field-353-5" name="nf-field-353" class="ninja-forms-field nf-element " value="emergency-department" aria-labelledby="nf-label-field-353-5" required="">
<label for="nf-field-353-5" id="nf-label-field-353-5" class="">Emergency Department</label>
</li>
<li>
<input type="checkbox" id="nf-field-353-6" name="nf-field-353" class="ninja-forms-field nf-element " value="newspaper-advertising" aria-labelledby="nf-label-field-353-6" required="">
<label for="nf-field-353-6" id="nf-label-field-353-6" class="">Newspaper Advertising</label>
</li>
<li>
<input type="checkbox" id="nf-field-353-7" name="nf-field-353" class="ninja-forms-field nf-element " value="government-agency" aria-labelledby="nf-label-field-353-7" required="">
<label for="nf-field-353-7" id="nf-label-field-353-7" class="">Government Agency</label>
</li>
<li>
<input type="checkbox" id="nf-field-353-8" name="nf-field-353" class="ninja-forms-field nf-element " value="radio-advertising" aria-labelledby="nf-label-field-353-8" required="">
<label for="nf-field-353-8" id="nf-label-field-353-8" class="">Radio Advertising</label>
</li>
<li>
<input type="checkbox" id="nf-field-353-9" name="nf-field-353" class="ninja-forms-field nf-element " value="ndia" aria-labelledby="nf-label-field-353-9" required="">
<label for="nf-field-353-9" id="nf-label-field-353-9" class="">NDIA</label>
</li>
<li>
<input type="checkbox" id="nf-field-353-10" name="nf-field-353" class="ninja-forms-field nf-element " value="tv-advertising" aria-labelledby="nf-label-field-353-10" required="">
<label for="nf-field-353-10" id="nf-label-field-353-10" class="">TV Advertising</label>
</li>
<li>
<input type="checkbox" id="nf-field-353-11" name="nf-field-353" class="ninja-forms-field nf-element " value="public-guardian" aria-labelledby="nf-label-field-353-11" required="">
<label for="nf-field-353-11" id="nf-label-field-353-11" class="">Public Guardian</label>
</li>
<li>
<input type="checkbox" id="nf-field-353-12" name="nf-field-353" class="ninja-forms-field nf-element " value="boosted-pro-app" aria-labelledby="nf-label-field-353-12" required="">
<label for="nf-field-353-12" id="nf-label-field-353-12" class="">Boosted Pro App</label>
</li>
<li>
<input type="checkbox" id="nf-field-353-13" name="nf-field-353" class="ninja-forms-field nf-element " value="healthcare-professional" aria-labelledby="nf-label-field-353-13" required="">
<label for="nf-field-353-13" id="nf-label-field-353-13" class="">Healthcare Professional</label>
</li>
<li>
<input type="checkbox" id="nf-field-353-14" name="nf-field-353" class="ninja-forms-field nf-element " value="friend-family-member" aria-labelledby="nf-label-field-353-14" required="">
<label for="nf-field-353-14" id="nf-label-field-353-14" class="">Friend/Family Member</label>
</li>
<li>
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Skip to main content Enable accessibility for visually impaired Open the accessibility menu Dictionary mode active. To define a word: Select any word on the page or hit "CTRL+M" on your keyboard Skip to content EMERGENCY ASSISTANCE Search for: ABORIGINAL HEALTH & WELLBEING * Aboriginal Health Worker Service * Yudhilidin * Aboriginal Care Coordination * YARN Psychology Services * Aboriginal & Torres Strait Islander Aftercare Program GENERAL HEALTH & WELLBEING * ACE: Aged Care Emergency Service * Care Coordination * Priority Allied Health Service * GP Access After Hours DISABILITY & WELLBEING * NDIS Services * NDIS Support Coordination * NDIS Allied Health MENTAL HEALTH & WELLBEING * headspace Newcastle * Hunter Psychosocial Support Service * The Way Back Support Service * Psychology Services How to Refer GENERAL HEALTH & WELLBEING * ACE: Aged Care Emergency Service * ACE Education and Resources DISABILITY & WELLBEING * Level 3 NDIS Support Coordination MENTAL HEALTH & WELLBEING * Suicide and Self-harm Services * Psychology Services for Aged Care Residents BUSINESS SERVICES * IT Services How to Refer * Our Business * Governance * Reconciliation Action Plan * Diversity and Inclusion * Research and Innovation * Membership * Scholarships and Grants * GP Access Snapshot * Our People * Meet the Board * Meet the Executive Team * Careers * NDIS Staff Profiles * Psychology Clinical Staff * Media * Media Releases * Publications and Resources * Our Videos * News Home * General Health & Wellbeing * Aboriginal Health * Mental Health * Disability * COVID-19 Search for: * Home * For Individuals and Carers * For Health Professionals * About Us * News * Contact Us * Emergency Assistance Search for: * Home * For Individuals and Carers * For Health Professionals * About Us * News * Contact Us * Emergency Assistance * Home * For Individuals and Carers * For Health Professionals * About Us * News * Contact Us * Emergency Assistance * Home * For Individuals and Carers * For Health Professionals * About Us * News * Contact Us * Emergency Assistance Search for: Home » For Individuals & Carers » Mental Health and Wellbeing Services » Hunter Psychosocial Support Service Hunter Psychosocial Support ServiceAlena Buesnel2021-04-09T12:22:14+10:00 HUNTER PSYCHOSOCIAL SUPPORT SERVICE ASSISTING PEOPLE WITH SEVERE MENTAL ILLNESS BUILD DAILY LIVING SKILLS AND CONNECT WITH SERVICES Our Hunter Psychosocial Support Service (HPSS) aims to assist people with severe mental illness, who have reduced psychosocial function and are not eligible for assistance through the NDIS to build daily living skills and connect with services based on their goals. While the NDIS provides comprehensive support for the majority of people with severe mental illness, you might not meet the NDIS criteria but may still benefit from specialised psychosocial support at certain times. HOW WILL HPSS HELP ME? Our Skills Facilitators can help you identify and work towards your goals in one of the following key areas: * Social skills and friendships * Vocational skills and goals * Educational and training goals * Maintaining physical wellbeing * Managing daily living needs * Building life skills * Family connections * Financial management and budgeting * Finding and maintaining a home * Managing drug and alcohol addictions (including tobacco) Your Skills Facilitator will work with you to develop a Capacity Action Plan which will include your goals, strategies and support systems. A Mentor or Peer Worker will assist you to implement your Capacity Action Plan by working alongside you to build your skills and community connections. AM I ELIGIBLE? Our HPSS Service is available to people with a severe mental illness who: * Live or work in the Newcastle, Upper Hunter, and Port Stephens regions * Have an associated level of reduced psychosocial functional capacity * Are not eligible for assistance through the NDIS * Are not currently receiving support through NPS - Extension or Continuity of Support (previously known as Partners in Recovery (PIR)) * Are not a client of Community Living Support (CLS) or Housing and Support Initiative (HASI) HOW TO REFER Referrals to our Hunter Psychosocial Support Service can be made completing our online referral form. If referrals are received for Lake Macquarie and Mid Coast regions, our intake team will contact you and direct you to the appropriate service provider in that area. For more information about our Hunter Psychosocial Support Service, contact the HPSS team on (02) 4925 2259 or email mhcc@hunterprimarycare.com.au Complete HPSS Online Referral HUNTER PSYCHOSOCIAL SUPPORT SERVICE (HPSS) REFERRAL AND INTAKE FORM Notice: JavaScript is required for this content. Fields marked with an * are required Referral Date Email Is this referral for yourself? * Yes * No Divider -------------------------------------------------------------------------------- Person Information PERSON INFORMATION First Name * Last Name * Street Address * Suburb * Postcode * Date of Birth * Age * Mobile Phone * Landline Phone Email Gender * * Male * Female * Non-Binary/Gender Fluid * Different Identity (please specify below) Other Response Identifies As * * Aboriginal but NOT Torres Strait Islander * BOTH Aboriginal & Torres Strait Islander * NEITHER Aboriginal or Torres Strait Islander * Torres Strait Islander but NOT origin * NOT stated/adequately described Mob or Country Country of Birth Is an Interpreter Required * Yes * No Resident of Australia * Yes * No Divider -------------------------------------------------------------------------------- The person has a diagnosed mental illness that is severe in degree * * Yes * No Is the person a participant of the NDIS? * Yes * No Is the person currently receiving support from NPS - Extension or Continuity of Supports? * Yes * No Is the person currently a client of Community Living Support (CLS) or Housing and Support Initiative (HASI)? * Yes * No What psychosocial areas are significantly impacted by their mental illness? (select all that apply) * * Social skills and friendships * Vocational skills and goals * Education and training * Maintaining physical wellbeing * Daily living needs * Building broader life skills * Family connections * Financial management and budgeting * Finding and managing a home * Managing drug and alcohol addiction, including tobacco Does the person have barriers to engaging with services at this time? * Yes * No Person (or Guardian) has consented to be involved with HPSS * * Yes * No How would the person benefit from a referral to HPSS? * Is the person in hospital at the time of referral? * Yes * No Divider -------------------------------------------------------------------------------- Referrer's Details REFERRER'S DETAILS Name Organisation Street Address Suburb Postcode Direct Phone Mobile Phone Email Referrer Type (eg. self, GP, Social Worker etc.) Recent history of service engagement Other services person is currently linked with (100 word limit) 100 of 100 Character(s) left Divider -------------------------------------------------------------------------------- Apparent co-existing factors that impact on mental illness * No * Not Reported * Unknown * Yes Drug or Alcohol Abuse * No * Not Reported * Unknown * Yes Intellectual / Cognitive Disability * No * Not Reported * Unknown * Yes Physical Disability * No * Not Reported * Unknown * Yes Sensory or Speech * No * Not Reported * Unknown * Yes Significant Physical Issues * No * Not Reported * Unknown * Yes Acquired Brain Injury * No * Not Reported * Unknown * Yes Dementia * No * Not Reported * Unknown * Yes ALERTS OR RISKS WE NEED TO BE AWARE OF * * Vicious Animal/s * Firearms/Weapons * Self Harm * Suicidal Ideation * Domestic Violence * Harm to Others * House in Poor Condition * No Risks Identified Divider -------------------------------------------------------------------------------- Where did you hear about Hunter Primary Care HPSS Support? * * Social Media * Referral * Internet Search * GP Waiting Room * Digital/Online Advertising * Emergency Department * Newspaper Advertising * Government Agency * Radio Advertising * NDIA * TV Advertising * Public Guardian * Boosted Pro App * Healthcare Professional * Friend/Family Member * Hunter Primary Care Staff * Other (please provide details below) * Other Service Provider (please provide details below) Other Response Have you? * Seen our TV commercial * Heard our radio commercial * Seen our bus advertising * Seen our newspaper advertisements * Seen our online advertising * None of the above If you are a human seeing this field, please leave it empty. HOW TO REFER We accept both self-referral or professional referral to our Hunter Psychosocial Support Service. For more information or to discuss a referral please contact our friendly team on 02 4925 2259 or complete our referral form and we will contact you. 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DIVERSITY COMMITMENT Hunter Primary Care is committed to embracing diversity and eliminating all forms of discrimination in the provision of health services. We welcome all people irrespective of ethnicity, lifestyle choice, faith, sexual orientation and gender identity. OUR FUNDING Hunter Primary Care acknowledges the program funding received from Hunter New England Central Coast Primary Health Network and The Department of Health. Page load link Go to Top JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember MonTueWedThuFriSatSun 281234567891011121314151617181920212223242526272829303112345678910