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Healthcare Provider Client Referral Form

This form is for healthcare professionals to refer clients who may benefit from our services. Please provide the necessary details to ensure a smooth intake process and appropriate support for your client. All information submitted is confidential and will be used solely for referral purposes.

Kindly advise your client that one of our friendly and highly experienced Behaviour Specialists with be in touch for a consultation to identify the most suitable service to meet their unique needs.

If you have any questions, feel free to contact us directly on (02) 8536 6655 or admin@freedomtherapyservices.com.au.

Thank you for your referral and trust. We look forward to supporting your client here at Freedom Therapy Services.

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About Freedom Therapy Services

We are a NDIS-registered provider offering flexible support services in clinic (Caringbah, Sutherland Shire), at home, in the community, or via telehealth across Greater Sydney.

At Freedom, we focus on socially significant goals to enhance independence, social connection, and quality of life, equipping participants and their families with essential skills. We are an inclusive community, with programs designed for, but not limited to, those with developmental disabilities. 

Client's Full Name *
Client's Age *
Client's Diagnosis (if applicable)
Primary Caregiver Full Name (if applicable) *
Email *
Phone Number *
Address (Suburb) *
Referred Service *
Required
Reason for Referral *
Referring Provider Name, Service Provider, and Contact *
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