First-Access-SD-CC-T7-Client-Exit-Form-V1.0-ID-205758

5 DF 752 CB 68 EECFF 675733742 FCFA 8 FAA 30 D 841 C 6. DOCX © 2023 E DUWORKS R ESOURCES P AGE 1 Client Exit Form This form is to be completed when a client is exiting or transitioning from services provided by First Access. Client details Client’s name: Current address: Phone number: Date of birth Age: Gender identity Which internal services did the client access (tick services received)?  Women’s health  Women’s sexual health  Assistance with emergency care  Support with domestic violence situations  Emotional support  Emergency accommodation  Children’s programs  Specialist child worker  Art activities and play – a program designed to help children to process their experiences  Assistance with referrals to other services External service Service provider Service ongoing (O) or complete (C) Which external services did the client access (please specify service and organisation)?  Child protection  Aboriginal services  Police  Centrelink  Housing  Financial assistance and advice  Legal Aid  Employment services