Client Registration

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* 1. Client Details

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* 2. What is your current postcode?

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* 3. Date of Birth

Date / Time

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* 4. What is your gender?

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* 5. What is your country of birth?

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* 6. What is your preferred language?

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* 7. What is your ethnicity?

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* 8. Do you identify as an Australian or Torres Strait Islander?

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* 9. Referral Source - by Person (Select One ONLY)

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* 10. Referral Source - by other source (Select one only)

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* 11. What is your current work status?

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* 12. What is your current martial status?

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* 13. Accommodation Setting┬á´╗┐(What best describes where you are currently living? Select one ONLY)

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* 14. Contact Phone Number

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