Adelaide Narrative Therapy Collective

Lawyer Referral Form

Referral Details

Client Details

Other Parties

Child Name
Date of Birth

Referral Type

Referral Context

Please provide any information that may assist with the commencement of services:

Therapeutic Appraisal

The practitioner will undertake an independent therapeutic appraisal of:

  • The client's circumstances, experiences, concerns, and hopes;
  • The broader relational, family, and social context in which those concerns arise;
  • Parenting and co-parenting circumstances where applicable;
  • The experiences, wellbeing, and needs of any children involved;
  • The perspectives, relationships, and involvement of significant family members and other relevant parties;
  • Safety, risk, protective factors, strengths, and resources;
  • Any matters considered relevant to the provision of counselling, family therapy, reunification work, child-inclusive practice, or family law counselling services.

The practitioner retains responsibility for determining the focus, direction, and scope of therapeutic engagement.

The therapeutic appraisal is not limited to matters identified within the referral and may include consideration of relational, developmental, social, cultural, legal, and family factors that emerge during the course of counselling.

Current Legal Context

Additional Information

Documents Provided

Please indicate any documents attached to this referral:

Communication Preferences

Fees and Reports

Current fees are:

  • Individual Counselling / Family Law Counselling: $180 per session
  • Reunification Preparation Sessions (Adult): $165 per session
  • Parent–Child / Family Sessions: $250 per session

Clients should generally anticipate attending a minimum of six to eight sessions before a report can reasonably be considered.

Additional fees:

  • Letter of Attendance: $450
  • Non-Court Ordered Progress Report: $800
  • Court-Ordered Report / Comprehensive Family Law Report: $1,800–$2,000
  • Subpoena Response or Production of Notes: $60 plus any reasonable copying, preparation, and administrative costs where applicable.

All report writing and court-related documentation are charged separately from counselling sessions.

Acceptance of a referral does not guarantee that a report will be provided. The practitioner retains discretion regarding whether sufficient therapeutic engagement has occurred to support the preparation of a report.

Referral Acknowledgement

The referring lawyer acknowledges that:

Lawyer Declaration

I confirm that the client is aware of this referral and, where appropriate, has consented to the sharing of information necessary to facilitate therapeutic services.

Practice Use Only

Date Received: _____ / _____ / _______
Practitioner: ____________________________
Initial Appointment: _____ / _____ / _______
Referral Accepted: ☐ Yes    ☐ No
Document Control: ANTC-FRM-LRF-001Version: 1.0Review Date: _____ / _____ / _______

Adelaide Narrative Therapy Collective — ANTC-FRM-LRF-001 v1.0

"The problem is not an 'obstacle'; it is the surpassing of the obstacle, a pro-jection."

— Deleuze & Guattari, A Thousand Plateaus (p. 362)

We acknowledge the Kaurna people as the traditional custodians of the Adelaide Plains and respect their enduring connection to the spirit and soul of this place. Though imperfect as allies, we strive to keep the past and present lived experience of Australia's First Nations people in the forefront of our minds during every conversation.

Adelaide Narrative Therapy

T: +61 46 883 0881info@adelaidenarrative.com

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