VOCAT / Anglicare Victims Assistance Program Session Attendance Form In order for us to claim for your VOCAT / Anglicare Victims Assistance Program session, we must get your written confirmation of your attendance. When using Telehealth (phone and/or video conference) this confirmation can be provided through completing this form. Name of person completing form (required) First Name Last Name Email so you get a copy of this form (required) If you don't have one, you can use a trusted person's email Relationship to Patient/Client (required) SelfParent / GuardianPartnerFamilyFriend Details of the telehealth session to be claimed through VOCAT / Anglicare Victims Assistance Program Name of Patient / Client (required) First Name Last Name My psychologist / provider is (required) Eryn BroughtonCandice BowersJeff Broughton Telehealth session time and date (required) (in YYYY-MM-DD format (e.g. 2013-04-08)) Date: Time: Hour Minute AMPM I confirm the above information is true and correct. I confirm I (and/or the above mentioned client) attended the above session. Signature (required)