Caregiver Referral for Student Counselling, Macleans College:
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Your full name *
If you are not the assigned caregiver, please provide your phone number or email address *
Your relationship to the student *
Students full name *
Student's form class or year level *
Tell us about your concerns or the issues affecting the student *
Do you have any concerns around safety (harm to self or others) *
If YES, please explain safety concerns
Is the student aware of this referral? *
Are there any other agencies that are involved or are assisting the student? *
If YES, which agencies are involved or assisting?
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