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Referral form in a clipboard sitting on a desk

Resources

Family referral form

Use this form to quickly and easily refer a family to Redkite.

Family referral form

Referrer details
Diagnosed child/young person details
Gender
Diagnosis and treatment
Client details of who you are referring (if different from the diagnosed child/young person already noted above)
Support and Terms
What support is required?
Privacy statement & declaration of consent

Redkite respects our client’s right to privacy. In order to determine eligibility for assistance and provide this service, we need consent to collect, store and use the client’s personal information, including sensitive information such as health details. Here are a few things we’d like you to know about the way Redkite handles private data.

Privacy statement

The personal information provided here is collected, stored and used by Redkite in accordance with the Australian Privacy Principles and our Privacy Statement to determine eligibility, provide services and send Redkite communications to clients and other members of their family. We may also seek participation in relevant research and evaluation involving personal information. For further information on the way Redkite manages and uses personal information please refer to the Redkite Privacy notice here.

Declaration of consent

Your signature declares that verbal consent has been obtained from the person being referred and the person has consented to their contact details and other personal information being collected, stored and used by Redkite for the purposes specified in this document, and this has been recorded in your case notes. If submitted by fax, you are required to physically sign this form. If submitted online, you are not required to physically sign this form as long as we receive a valid email signature with your full name, title and hospital details.

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Need help or advice from us? Then get in touch!

Call 1800 REDKITE Mon – Fri 9am – 7pm (AEST)
Mon – Fri 9am – 7pm (AEST)
24/7

29th Sep

Walking alongside

The Walking Alongside video and Conversations Starters Guide are designed for health professionals who do not regularly encounter paediatric patients with life-limiting illnesses and/or paediatric deaths.

Walking alongside

The Walking Alongside video and Conversations Starters Guide are designed for health professionals who do not regularly encounter paediatric patients with life-limiting illnesses and/or paediatric deaths.

Downloads
21st Sep

Conversation starters

A worksheet to accompany the video ‘Walking Alongside: a guide for health professionals caring for a dying child.

Conversation starters

A worksheet to accompany the video ‘Walking Alongside: a guide for health professionals caring for a dying child.

Man looking at myRedkite on his mobile phone

Organising
21st Sep

myRedkite FAQs

Resources myRedkite FAQs If your child’s cancer is making it hard to pay the household bills, register with myRedkite. myRedkite…

myRedkite FAQs

Resources myRedkite FAQs If your child’s cancer is making it hard to pay the household bills, register with myRedkite. myRedkite…