Referral Form

Lumera Recovery Pathways support clients with alcohol and other drug issues and families who have a loved one with these issues.

Lumera Recovery Pathways works with our clients to achieve their desired outcomes by skilfully assessing their unique situations, offering personalised education, making recommendations, liaising with their current treatment team, facilitating referral to other services, and most importantly tailoring a recovery plan individualised accurately to our client’s needs. Furthermore, we offer ongoing coaching support to assist clients in maintaining change. Challenges are guaranteed to come, so we want to be there to walk this path with our clients when they arrive.

* Please note this is a fee for service provider. No rebates are currently available. Lumera Recovery Pathways do not prescribe medication during any stage of the client journey.

Client Details

Client Name

First Name

Last Name

DOB

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Consent

Consent to leave messages, email and text

Reason for referral

Client detoxification pathway planning, preparation, and referral

Relapse prevention and recovery coaching

Family/significant other support, education, and referral

Other

Current Issues

Relevant Medical Information

Referrer Details

Practitioner Name

First Name

Last Name

Job title

Service/ Company

Phone

(###)

###

####

Fax

Client Consent to referral

The client has consented to this referral being sent to Lumera Recovery Pathways and consent to the referrer receiving an update in regard to the outcome of the referral

The client is aware that Lumera Recovery Pathways is a fee for service provider and that limited consultation can be provided unless a formal booking is made via our website lumerapathways.au