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Referrals

About
Services
Employment
- Careers
Training and Resources
- Introduction to Working with Young People and Substance Issues
- Annual Reports and Strategic Plans
Membership
- Membership
Contact
Donate
Referrals

Healthy Families Program (AOD) Referral

Please complete the referral form below and our Heath and Intake Coordinator will be in touch with you as soon as possible to discuss your referral. If you have any trouble completing the form, please contact us.

Where possible, we prefer to do assessments in person, however if the applicant is outside of the Darwin area or is incarcerated, we can complete assessments via phone.

Following assessment, CAAPS’ intake panel will assess the client’s suitability to enter the program. If the client is suitable we will contact them to confirm an entry date. If the client is found not suitable, CAAPS will assist in referrals to other services if required.

Who is referring you to CAAPS*
Referral Type*
Client currently incarcerated*
- No
- Yes
Please upload 100 points of full colour ID (front and back)
For more information, contact CAAPS.
Drop files here or

Max. file size: 128 MB.
Date of incarceration
Next court date or date of release
Current Charges and Facts
Drop files here or

Max. file size: 128 MB.
NT Priors
Drop files here or

Max. file size: 128 MB.
Interstate Priors (if applicable)
Drop files here or

Max. file size: 128 MB.
Referral Information

(To be completed by person making referral together with the client.)
Name of Referrer*
Organisation
Contact No*
Email*
Applicant Details
Name*
Other Names
Date of birth
DD slash MM slash YYYY
Interpreter needed
- Yes
- No
Medicare Number
Language spoken
Centrelink Number
Please attach current Centrelink summary
Drop files here or

Max. file size: 128 MB.
Ethnicity
- Aboriginal
- Torres Strait Islander
- Aboriginal and Torres Strait Islander
- Other
Gender
- Male
- Female
- Other
Current Address or Post Code
Home community
How long Since you lived there?
Phone/ Mobile number
Phone/ Mobile number*
Emergency Contact Details
Name
Relationship to you
Address
Phone No
Postcode
how many family members would you like to enter the program with you?
Relationship and names of other family members who you want to enter the program with you
Name
Relationship
Age
Name
Relationship
Age
Name
Relationship
Age
Name
Relationship
Age
Name
Relationship
Age
Name
Relationship
Age
Name
Relationship
Age
Name
Relationship
Age
Name
Relationship
Age
Name
Relationship
Age
Consent to Collect & Store Data*
I hereby authorise information regarding my background (including health, home life, legal status, etc.) to be collected and stored on the CAAPS Data Base and the government Data Base Ship to Shore for reporting purposes. CAAPS accesses eHealth Database to obtain health related information. If you do not agree, select no. However, we may not be able to process your application.
- Yes
- No
Release of Information*
I hereby authorise information regarding my background (including health, home life, legal status, etc.) to be exchanged between the CAAPS Aboriginal Corporation and... (check all that apply)
- Yes to all listed
- Community Corrections
- Territory Families
- NT Police
- NT Department of Health
- No
Client Declaration*
I confirm that I have completed this form and that I fully understand the purpose and nature of this referral. I understand that any information exchanged will only be used to assist in providing appropriate service support and will not be given to any other program or person without written permission.
- Yes
- No
Referrer Declaration*
I confirm that I have completed this form in the presence of the client and that I have ensured the client fully understands the purpose and nature of this referral. Where the client is not proficient in English, I confirm that I used Aboriginal Interpreter Services (89998353).
- Yes
- No
Any information exchanged will only be used to assist in providing appropriate service support and will not be given to any other program or person without written permission.
I understand that if another agency is requesting information regarding the client which does not relate to their current participation in the CAAPS program, staff will request permission from you in writing before providing any information (this excludes statutory information sharing e.g. DCF, Mandatory Reporting).*
- Yes
- No
CAPTCHA

Criminal History Checks

CAAPS requires a criminal history check for anyone staying with us over the age of 16.

More Information

CAAPS Aboriginal Corporation
Address: 60 Boulter Road Berrimah NT 0828
Freecall (NT only): 1800 894 800
Phone: (08) 8922 4800
Business Hours: Mon-Fri 8AM-4PM

QIC accredited since 2015, certified in 2025

We acknowledge the traditional owners and custodians of country throughout Australia and their continuing connection to land, sea and community. We pay our respects to them and their cultures, and to their elders both past and present.

CAAPS Aboriginal Corporation is committed to creating a safe, respectful, and inclusive environment where everyone is valued. We celebrate diversity and believe that inclusion strengthens our community and the work we do.

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Healthy Families Program (AOD) Referral

Please complete the referral form below and our Heath and Intake Coordinator will be in touch with you as soon as possible to discuss your referral. If you have any trouble completing the form, please contact us.

Where possible, we prefer to do assessments in person, however if the applicant is outside of the Darwin area or is incarcerated, we can complete assessments via phone.

Following assessment, CAAPS’ intake panel will assess the client’s suitability to enter the program. If the client is suitable we will contact them to confirm an entry date. If the client is found not suitable, CAAPS will assist in referrals to other services if required.

Referral Information

Applicant Details

Emergency Contact Details

Criminal History Checks