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    Liight Me Up Again Services

    ABN:48532028139

    Client Intake Form – Social Work

    Thank you for choosing Liight Me Up Again Services. This form helps us understand your background, needs, and goals so we can provide safe, effective, and culturally respectful social work support.



    Client Information:





    Emergency Contact




    In-person (local)Virtual (International/Local)



    Referrer Details



    Self-ManagedPlan-ManagedAgency-Managed


    Drop files here or click to upload.

    Upload up to 5 files




    AboriginalTorres Strait IslanderBothOther Indigenousnon-indigenous


    YesNo


    Section 1: Presenting Needs

    Risk of self-harmRisk of harm to othersFamily/domestic violenceHomelessnessAbuse/neglect concernsOthers


    Section 2: Goals & Outcomes

    Emotional support / trauma recoveryCrisis interventionAdvocacy (housing, Centrelink, community services)Capacity building (skills, independence, resilience)Other


    Section 3: Background Information




    Service Terms & Conditions*


    • I understand that social work services are non-clinical, designed to provide support, advocacy, and capacity building.
    • I understand that this form and all materials provided are for my personal use within session and remain the property of Liight Me Up Again Services. I agree not to reproduce, share, or distribute these materials without written consent. I have read and agree to the Service Agreement.
    • I understand that this form and all materials provided are for personal use within my coaching sessions and remain the property of Liight Me Up Again Services.
    • I understand that I am responsible for my own choices and outcomes, and that the provider offers guidance and advocacy, not guarantees..
    • For NDIS participants: services will be delivered in line with my NDIS Plan goals, and reports/invoices will be provided as required.
    • I consent to referrals or information sharing only when necessary to ensure my safety or to coordinate supports (with my consent, unless legally required otherwise).
    I agree and consent to social work services under these terms.




    © 2025 Liight Me Up Again Services – All Rights Reserved.
    This form is proprietary and provided solely for the personal use of clients of Liight Me Up Again Services. It may not be copied, reproduced, or distributed without prior written consent.
    Liight Me Up Again Services | www.liightmeupagain.com | hello@liightmeupagain.com
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