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Child intake assessment form

Your honesty is important and your answers will help us to plan the best treatment options with and for you, while providing the best possible care for you and your child(ren).

Before you start, our Privacy Policy tells you how we will use your information.  Please view it here.

We’ll keep your information private as far as possible, however, in accordance with state and federal legislation, it may become necessary that we disclose certain information to health providers and government departments for the wellbeing of you and your children.

A separate form must be completed for each child.

Emergency contact for retrieval of child(ren)


The Women’s Alcohol and Drug Advisory Centre acknowledges and pays respect to the past, present and future Traditional Custodians and Elders of this nation and the continuation of cultural, spiritual and educational practices of First Nations peoples.

We proudly acknowledge that we work on the land of the Bidjigal peoples who traditionally occupied the Sydney coast.

We are a Registered Charity and accredited under the Australian Service Excellence Standard.  Our service is founded on compassion.

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The Jarrah House privacy policy can be found here
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