Skip to content

Nation-Wide Locations
Head Office: 07 4864 9888
1800 007 888
Account

Resize text-+=

Home
About
Services
NDIS
What We Do
Therapies
Workshops
Train the Trainer
Camps

Art Therapy

Sandplay Therapy

Drumming Therapy

Laughter Therapy

Drama / Movement Therapy

Music/Movement Therapy

Hypnotherapy

Time Line Therapy

Psychotherapy

NLP – Neuro Linguistic Programming Therapy

Dietitian Consulting

Community Support Workers

Parent / Child Connection Through Art Workshops

Managing Emotions and Stress In Teens Workshops

Understanding Children of Today Workshops

Understanding Children In Care Workshops

Wellness (Who Am I?) Workshops

Mind Setting Workshops

Laughter Workshops

Drumming Workshop

Drama / Movement Workshop

Music / Movement Workshop

Living With ASD (Autistic) Workshop

Living with Dementia Workshop

Domestic Violence Awareness Workshop

Professional Speaker Training

Teacher Training Video (For All Schools)

Parent / Child Connection Through Art

Managing Emotions and Stress In Teens

Understanding Children Of Today

Understanding Children In Care

Who Am I? Facilitator Training Course

Mind Setting Training Course

Laughter Facilitator Training

Drumming Training Course

Living With ASD (Autism Spectrum Disorder) Training

Domestic Violence Awareness

Living with Dementia
Kool Kids
Events
Shop
Contact
- Meet Our Therapists
- Meet Our Team

Referral Form New

Please complete all required fields in the referral form below.

Empowered Therapy and Training Nationwide Referrals

ABN: 55 637 079 620

This referral must be actioned:^*

Urgently

Within the next 2 weeks

Other

Client Details

Are you a:^*

Private Referral

NDIS Participant

Requesting ETT Plan Manager

Payments:^*

EZYPAY

EWAY

Client/Participant Name^*

Prefix

First Name

Middle Name

Last Name

Date of Birth:^* Date

Home Address:^*

Mobile Number:^*

Mobile Number

Email:^*

example@example.com

Current Client Diagnosis (ASD, OCD etc):^*

Intensity of suicidal thoughts:^*

1 Low

2

3

4

5

6

7

8

9

10 High

Intent to carry out suicidal thoughts:^*

1 Low

2

3

4

5

6

7

8

9

10 High

Next of Kin - Contact #1:^*

Name:

Mobile Number:

Email Address:

Home Address:

Relationship to client/participant:

Next of Kin - Contact #2:^*

Name:

Mobile Number:

Email Address:

Home Address:

Relationship to client/participant:

Invoice to^*

First Name

Last Name

Invoicee's Organization Name^*

Invoicee's Mobile Number^*

Please enter a valid Mobile number.

Invoicee's Email^*

example@example.com

Short-term Goals^*

Long-term Goals^*

Supports Required

Number of session you want:^*

20 sessions

30 sessions

40 sessions

Other

What schedule you want^*

Weekly

Fortnightly

I want to know more about your events^*

Yes

No

Any further information you would like us to know:

Health Documents

Open Form In New Window

Click To View Nationwide Locations

Follow Empowered

Facebook-f Instagram Twitter Linkedin-in

Follow Kool Kids

Facebook-f Youtube Twitter Linkedin-in

Quick Links

About Us
Shop
When I Work
Members Portal
Privacy Policy
Cancellation Policy
Refund Policy
Terms & Conditions

How We Can Help

Art Therapy
Laughter Therapy
Drumming Therapy
Drama Therapy
Sandplay Therapy
Music/Movement Therapy
NLP Therapy
Psychotherapy
Hypnotherapy

NDIS

What is NDIS?
Accessing NDIS
Am I eligible for the NDIS?
Temporary Transformation Payment
NDIS FAQs
NDIS Resources
Plan Management
Contact Us
Client Feedback Survey

Latest News

Recent Posts

How to Deal with Change and Uncertainty
Parenting Teen Girls: Navigating Their Fears, Challenges & Peer Pressure
10 Ways to Build and Preserve Better Boundaries in Your Life
10 Ways Your Kids Will Help You Become a Better Person
Spacious, Disability-Friendly Home and Therapy Services: A Holistic Approach to Care

© Copyright 2021 Empowered Therapy & Training All Rights Reserved | ABN: 55 637 079 620

Website by OnePoint Solutions