Family Supervision Referral Form

Please complete this form and forward it to the other parent through your appropriate communication channel (i.e. via legal representatives or other means) for their agreement and signature.

To commence intake to our service we require the Referral Form and Service Agreement documents to be forwarded to the PRFC office. If you make amendments to the information on this form completed and signed by the other parent, please return the form to the other parent for agreement to those changes PRIOR to sending to PRFC.

We will not accept Referral Forms that are not signed by both parents showing agreement to the arrangement for the visitation.
The completed form can be sent as an email attachment along with receipt for intake payment by mail or fax:

Mail: PO Box 71, Oatlands NSW 2117
Fax: 02 9875 2123

This form is the sole document we will refer to for your contact supervision arrangements, including agreed venues and attendees.

If a parent requires a change to this arrangement, this must be communicated to the other parent then the parents will need to again show their agreement to the change requested.
PRFC is not able to negotiate between the parties. Therefore, ALL negotiations must be completed by the parents, and this may involve their legal representation.

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