Individual Referred for Peer Support

Referral Type Referral Type Self (for myself) Peer (for a colleague) QA referral (automatic, following a significant event or case review)

Reason for Referral (check any that apply) Reason for Referral (check any that apply) Challenging or traumatic clinical event or situation Feeling emotionally overwhelmed or burned out Peer conflict Personal stressors that may be affecting my work/life balance General support Not sure — Just need to talk Other

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