Referral & Enquiry Form - Unfolding Life Stories

Thank you for referring a child or young person to Unfolding Life Stories. Please complete the form below to assist us in determining the most suitable service.

Referrer Details

Organisation / service (if applicable)

Referrer Name

Position/Role

Date of Referral

Phone

Email

Child / Young Person Details

Full Name

Preferred Name

Date of Birth

Age

Gender

Cultural Background

Current Placement/Living Arrangement

Parent / Carer / Guardian Details

Name(s)

Relationship to Child/Young Person

Phone

Email

Reason for Referral

Please provide a brief summary of the child or young person's circumstances and the reason for referral

Service Requested

Please tick the service you are referring for:

All About Me (6 Sessions)
A strengths-based program supporting identity, belonging, and understanding of personalexperiences.

More About Me (10–12 Sessions)
A more detailed exploration of the child or young person's life experiences, relationships, identity,and personal narrative.

Therapeutic Life Story Work (TLSW)
A structured therapeutic intervention helping children and young people make sense of their lifeexperiences, particularly trauma, loss, separation, and significant life events.

Identity & Story Workshops
A safe, reflective space for children & young people to explore their identity, experiences, stregnths and what makes their story uniquely theirs.

Unsure – Please advise the most suitable service

Goals and Outcomes

What outcomes are you hoping the child or young person will achieve through this service?

Improved understanding of personal historyStrengthened sense of identityIncreased emotional wellbeingSupport in making sense of trauma and life experiencesImproved connections and relationshipsDevelopment of a life story resourceOther

Please specify

Risks and Considerations

Are there any risks, behavioural concerns, or support needs we should be aware of?

Confidentiality and Information Sharing Statement

The purpose of all information gathered, reviewed, documented, and shared throughout the All About Me, More About Me, Therapeutic Life Story Work (TLSW) and Identitiy & Story Workshops is solely to support the development of a child or young person's life story and therapeutic understanding of their experiences.

Information may be collected from a variety of sources, including case files, reports, carers, professionals, birth family members, and other significant people in the child or young person's life. This may include documented interviews and personal reflections shared as part of the life story work process.

All information obtained will be treated with respect and confidentiality and will be used exclusively for the purposes of life story work.

Consent

I confirm that appropriate consent has been obtained for this referral and for relevant information to be shared with Unfolding Life Stories. *

Referrer Signature

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Date

Referral Submission

Unfolding Life Stories

Email: Deanna@unfoldinglifestories.com
Phone: 0476987076

Supporting children and young people to understand their stories, strengthen their identities, and build a sense of belonging.

Fees and Quotation

Fees for All About Me, More About Me, Identity & Story Workshops Therapeutic Life Story Work (TLSW) services are determined by the individual needs and circumstances of each child or young person.

For More About Me and Therapeutic Life Story Work (TLSW), the initial stage includes a free-of- charge consultation with the relevant care team to discuss the child or young person's history, current circumstances, goals for the work, available records, and the anticipated scope of the intervention.

This consultation assists in identifying the level of preparation required, including record reviews, interviews with significant people, direct work sessions, and the development of life story materials.

As a result, a detailed quotation cannot be provided until the referral has been received and the consultation has taken place.

Following the consultation, Unfolding Life Stories will provide the referring agency with:

A proposed scope of work.
An estimated timeframe for completion.
A detailed quotation outlining anticipated costs.
Recommendations regarding the most suitable life story work intervention for the child or young person.

No work will commence until the quotation has been reviewed and approved by the referring agency and/or funding body