Child’s Details
Gender identity (Required)
Australian citizen or permanent visa? (Required)
Under care of the minister? (Required)
Kinship or informal care arrangement? (Required)
Current Custody or Court Orders? (Required)
Existing parenting/custody/guardianship arrangement? (Required)
Identify as Aboriginal? (Required)
Identify as Torres Strait Islander? (Required)
Would you like the support of a First Nations community coordinator?

Our First Nations community coordinator can provide culturally safe support throughout the referral and service process.

Require an interpreter? (Required)
Parent/Carer/Child Representative
Australian citizen or permanent visa? (Required)
Gender identity (Required)
Relationship to child (Required)
Preferred Contact Method (Required)
Preferred correspondence (Required)
Would you like to be contacted for surveys?
Is there another person with parental responsibility for the child? (Required)
Additional Information
Does the child have a diagnosis? (Required)
Currently undergoing assessment for disability? (Required)
Are there developmental concerns? (Required)
Consent to Contact Services
Parent/Carer/Guardian Consent
Relationship to child (Required)

Please note: if you are submitting this referral form on behalf of a child and their parent/carer/child representative, Northcott is required to contact this person as per details listed above and obtain consent to proceed with the referral.

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Montrose is now part of Northcott!

Welcome to our new website.

If you have any questions, please speak to your Service Manager, Service Coordinator or call us on 1800 818 286.

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