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Advocacy Referral & Information Form

Below is an online advocacy referral form for Disability Advocacy NSW. This form is designed to be used by organisations and service providers wishing to refer a person with a disability to the service. Individuals with a disability and carers can still seek the assistance of an advocate by contacting us directly. The aim of this referral system is to ensure that we assist clients with the most urgent needs first.

After a referral is received we will prioritise the matter and contact the client and the referrer giving an indication of how long before an advocate can contact the client. Average waiting time is approximately 2 weeks.

It will help us a great deal if you can complete the referral form and add any additional information that will help us to quickly understand the issues involved. If you have any questions feel free to contact our advocates or try our web site www.da.org.au .

Below is an excerpt from our brochure about the advocacy services we provide:

ADVOCACY = “ ‘standing by’ someone, or ‘speaking out’ for someone’s rights, or ‘going into bat for another person --being ‘on their side’, especially when the chips are down.”

Who is the Advocacy Service for?

For people with any type of disability and their family or carers in the Hunter region (eg: a brain injury, an intellectual disability, a neurological disability, a physical disability, a psychiatric disability, a sensory disability)

Area Covered?

The service is funded for individual advocacy in the Hunter, New England and Mid North Coast regions. All referrals should be sent to da@da.org.au fax 02 4927 0114.

DA services are :

INDIVIDUAL ADVOCACY

Directly advocating on behalf of a person or providing information and advice so that a person can advocate for themselves (eg dealing with a landlord, support when going to court, support in dealing with the police or dealing with a legal issue, negotiating a better deal from a government department, dealing with guardianship and financial management orders, dealing with problems at work, school, TAFE or uni etc)
Linking a person with other relevant services (eg helping a person get legal advice from a solicitor).
Talking over a problem (eg Sometimes we can best help by simply listening and helping to think through options for moving forward)
Supporting an individual to take formal action on matters related to disability discrimination or making a complaint against a service provider (eg assisting a person to make a complaint with the Anti-Discrimination Board).
A specialist advocate for clients from a non-English background clients is available

To Find out more: Phone, email, fax or write to find out if we can be of assistance.

Has the person you are referring used the service before	Yes No
Clients surname
Clients first name
Phone
Email
Fax
Address (including post code)
Date of Birth	(dd/mm/yyyy)
What type of disability does the person have?
Cultural background? (eg. Non-English speaking background, Aboriginal, English speaking background)
Contact person/Carer? (If applicable, is there a family member, friend, carer that the service should know about?)
Has the client given permission for DA to contact them	Yes No
Referring person/Agency? (Referring person & agency's name, address, phone, fax and email)
Summarise the main issues (List any information that the service needs to know to assist the client? The more relevant information we know the quicker the referral can be dealt with)
What outcome does the client want? (How would they like an advocate to help?)
How urgent is the matter? (Is there upcoming events that the service needs to know about eg legal proceedings, eviction, appointments, deadlines etc?)

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