{"id":152,"date":"2024-01-18T06:55:08","date_gmt":"2024-01-18T06:55:08","guid":{"rendered":"https:\/\/breatherecoverconnect.com.au\/?page_id=152"},"modified":"2024-01-25T10:44:11","modified_gmt":"2024-01-25T10:44:11","slug":"psychosocial-recovery-coaching","status":"publish","type":"page","link":"https:\/\/breatherecoverconnect.com.au\/?page_id=152","title":{"rendered":"Psychosocial Recovery Coaching"},"content":{"rendered":"\n<div class=\"wp-block-group alignfull has-global-padding is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading has-text-align-left\"><strong>My aim is to develop a recovery-enabling relationship. <\/strong><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">I will provide you with honesty and integrity to help you reach your goals. I live and breathe a service to others. Through lived and educational experience, I aim to walk alongside you.<\/h3>\n\n\n\n<p class=\"has-small-font-size\">Supporting you in your recovery planning. I will Collaborate with the broader system of supports. This could look like care team meetings or calls and emails. I collaborate to understand your journey better. I work with mainstream mental health and wellbeing organizations. Like connecting you with <a href=\"https:\/\/www.betterhealth.vic.gov.au\/mhwlocal\">Mental Health and Wellbeing Locals<\/a> or other culturally appropriate supports not just NIDS specific. I have extensive connections and providers. This enables you Choice and Control in your options of support. Similar to a <strong><a href=\"https:\/\/breatherecoverconnect.com.au\/?page_id=126\">Support Coordinator<\/a><\/strong> I will help you understand your plan.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Recovery Coaching Tools <\/strong><\/h2>\n\n\n\n<p class=\"has-text-align-left has-text-color\" style=\"color:#636363;font-size:clamp(14px, 0.875rem + ((1vw - 3.2px) * 0.313), 17px);line-height:1.1\">I may use one or more of the following as recommended via <a href=\"https:\/\/www.ndis.gov.au\/understanding\/how-ndis-works\/mental-health-and-ndis#factsheets-and-resources\">NDIS for Recovery Coaches<\/a> <\/p>\n\n\n\n<p class=\"has-text-color\" style=\"color:#636363;font-size:clamp(14px, 0.875rem + ((1vw - 3.2px) * 0.313), 17px);line-height:1.1\">WRAP, Active8, Optimal Recovery, Collaborative Recovery Coaching Protocols14, My Mental Health Recovery Measure (RAS:DS), Beyond Now and PTSD Coach.<\/p>\n<\/div>\n\n\n\n<p> <\/p>\n\n\n\n<figure class=\"wp-block-gallery has-nested-images columns-default is-cropped wp-block-gallery-1 is-layout-flex wp-block-gallery-is-layout-flex\">\n<figure class=\"wp-block-image size-large is-style-default\"><img fetchpriority=\"high\" decoding=\"async\" width=\"800\" height=\"800\" data-id=\"183\" src=\"https:\/\/breatherecoverconnect.com.au\/wp-content\/uploads\/2024\/01\/She-Healed-because-she-loved-herself-first-1.png\" alt=\"\" class=\"wp-image-183\" srcset=\"https:\/\/breatherecoverconnect.com.au\/wp-content\/uploads\/2024\/01\/She-Healed-because-she-loved-herself-first-1.png 800w, https:\/\/breatherecoverconnect.com.au\/wp-content\/uploads\/2024\/01\/She-Healed-because-she-loved-herself-first-1-300x300.png 300w, https:\/\/breatherecoverconnect.com.au\/wp-content\/uploads\/2024\/01\/She-Healed-because-she-loved-herself-first-1-150x150.png 150w, https:\/\/breatherecoverconnect.com.au\/wp-content\/uploads\/2024\/01\/She-Healed-because-she-loved-herself-first-1-768x768.png 768w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large is-style-default\"><img decoding=\"async\" width=\"800\" height=\"800\" data-id=\"184\" src=\"https:\/\/breatherecoverconnect.com.au\/wp-content\/uploads\/2024\/01\/She-Healed-because-she-loved-herself-first-1-1.png\" alt=\"\" class=\"wp-image-184\" srcset=\"https:\/\/breatherecoverconnect.com.au\/wp-content\/uploads\/2024\/01\/She-Healed-because-she-loved-herself-first-1-1.png 800w, https:\/\/breatherecoverconnect.com.au\/wp-content\/uploads\/2024\/01\/She-Healed-because-she-loved-herself-first-1-1-300x300.png 300w, https:\/\/breatherecoverconnect.com.au\/wp-content\/uploads\/2024\/01\/She-Healed-because-she-loved-herself-first-1-1-150x150.png 150w, https:\/\/breatherecoverconnect.com.au\/wp-content\/uploads\/2024\/01\/She-Healed-because-she-loved-herself-first-1-1-768x768.png 768w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large is-style-default\"><img decoding=\"async\" width=\"800\" height=\"800\" data-id=\"185\" src=\"https:\/\/breatherecoverconnect.com.au\/wp-content\/uploads\/2024\/01\/She-Healed-because-she-loved-herself-first-2.png\" alt=\"\" class=\"wp-image-185\" srcset=\"https:\/\/breatherecoverconnect.com.au\/wp-content\/uploads\/2024\/01\/She-Healed-because-she-loved-herself-first-2.png 800w, https:\/\/breatherecoverconnect.com.au\/wp-content\/uploads\/2024\/01\/She-Healed-because-she-loved-herself-first-2-300x300.png 300w, https:\/\/breatherecoverconnect.com.au\/wp-content\/uploads\/2024\/01\/She-Healed-because-she-loved-herself-first-2-150x150.png 150w, https:\/\/breatherecoverconnect.com.au\/wp-content\/uploads\/2024\/01\/She-Healed-because-she-loved-herself-first-2-768x768.png 768w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><\/figure>\n<\/figure>\n\n\n<style id=\"wpforms-css-vars-root\">\n\t\t\t\t:root {\n\t\t\t\t\t--wpforms-field-border-radius: 3px;\n--wpforms-field-border-style: solid;\n--wpforms-field-border-size: 1px;\n--wpforms-field-background-color: #ffffff;\n--wpforms-field-border-color: rgba( 0, 0, 0, 0.25 );\n--wpforms-field-border-color-spare: rgba( 0, 0, 0, 0.25 );\n--wpforms-field-text-color: rgba( 0, 0, 0, 0.7 );\n--wpforms-field-menu-color: #ffffff;\n--wpforms-label-color: rgba( 0, 0, 0, 0.85 );\n--wpforms-label-sublabel-color: rgba( 0, 0, 0, 0.55 );\n--wpforms-label-error-color: #d63637;\n--wpforms-button-border-radius: 3px;\n--wpforms-button-border-style: none;\n--wpforms-button-border-size: 1px;\n--wpforms-button-background-color: #066aab;\n--wpforms-button-border-color: #066aab;\n--wpforms-button-text-color: #ffffff;\n--wpforms-page-break-color: #066aab;\n--wpforms-background-image: none;\n--wpforms-background-position: center center;\n--wpforms-background-repeat: no-repeat;\n--wpforms-background-size: cover;\n--wpforms-background-width: 100px;\n--wpforms-background-height: 100px;\n--wpforms-background-color: rgba( 0, 0, 0, 0 );\n--wpforms-background-url: none;\n--wpforms-container-padding: 0px;\n--wpforms-container-border-style: none;\n--wpforms-container-border-width: 1px;\n--wpforms-container-border-color: #000000;\n--wpforms-container-border-radius: 3px;\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\n\t\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-45603a91-6ae6-4ce5-9de7-3bdf8a08f7ab wpforms-render-modern\" id=\"wpforms-15\"><form id=\"wpforms-form-15\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"15\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F152\" data-token=\"85c302bf9125252f9af771bf3865e712\" data-token-time=\"1776789397\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-hidden\" id=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-15-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"1\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-15-field_1\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][1][first]\" aria-errormessage=\"wpforms-15-field_1-error\" required><label for=\"wpforms-15-field_1\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-15-field_1-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][1][last]\" aria-errormessage=\"wpforms-15-field_1-last-error\" required><label for=\"wpforms-15-field_1-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-15-field_20-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-15-field_20\">Preferred Pronouns\/ optional<\/label><input type=\"text\" id=\"wpforms-15-field_20\" class=\"wpforms-field-medium\" name=\"wpforms[fields][20]\" aria-errormessage=\"wpforms-15-field_20-error\" ><\/div><div id=\"wpforms-15-field_15-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-15-field_15\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-15-field_15\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][15]\" spellcheck=\"false\" aria-errormessage=\"wpforms-15-field_15-error\" required><\/div><div id=\"wpforms-15-field_19-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"19\"><fieldset><legend class=\"wpforms-field-label\">Address\/ optional <\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-15-field_19\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][19][address1]\" aria-errormessage=\"wpforms-15-field_19-error\" ><label for=\"wpforms-15-field_19\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-15-field_19-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][19][address2]\" aria-errormessage=\"wpforms-15-field_19-address2-error\" ><label for=\"wpforms-15-field_19-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-15-field_19-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][19][city]\" aria-errormessage=\"wpforms-15-field_19-city-error\" ><label for=\"wpforms-15-field_19-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-15-field_19-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][19][state]\" aria-errormessage=\"wpforms-15-field_19-state-error\" ><option class=\"placeholder\" value=\"\" selected disabled>&#8212; Select state &#8212;<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-15-field_19-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-15-field_19-postal\" class=\"wpforms-field-address-postal wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][19][postal]\" aria-errormessage=\"wpforms-15-field_19-postal-error\" ><label for=\"wpforms-15-field_19-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-15-field_11-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-15-field_11\">Phone number\/ optional<\/label><input type=\"tel\" id=\"wpforms-15-field_11\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][11]\" aria-label=\"Phone number\/ optional\" aria-errormessage=\"wpforms-15-field_11-error\" ><\/div><div id=\"wpforms-15-field_8-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-15-field_8\">NDIS Number\/ optional<\/label><input type=\"text\" id=\"wpforms-15-field_8\" class=\"wpforms-field-medium\" name=\"wpforms[fields][8]\" aria-errormessage=\"wpforms-15-field_8-error\" ><\/div><div id=\"wpforms-15-field_2-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"2\"><fieldset><legend class=\"wpforms-field-label\">Services you are requesting <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-15-field_2\" class=\"wpforms-field-required\"><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-15-field_2_7\" name=\"wpforms[fields][2]\" value=\"Specialist Support Coordiantion\" aria-errormessage=\"wpforms-15-field_2_7-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-15-field_2_7\">Specialist Support Coordiantion<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-15-field_2_6\" name=\"wpforms[fields][2]\" value=\"Support Coordination Level 2\" aria-errormessage=\"wpforms-15-field_2_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-15-field_2_6\">Support Coordination Level 2<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-15-field_2_2\" name=\"wpforms[fields][2]\" value=\"Psychosocial Recovery Coaching\" aria-errormessage=\"wpforms-15-field_2_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-15-field_2_2\">Psychosocial Recovery Coaching<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-15-field_2_5\" name=\"wpforms[fields][2]\" value=\"Wellbeing Skill Building\" aria-errormessage=\"wpforms-15-field_2_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-15-field_2_5\">Wellbeing Skill Building<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-15-field_2_4\" name=\"wpforms[fields][2]\" value=\"Accommodation and Tenancy Support\" aria-errormessage=\"wpforms-15-field_2_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-15-field_2_4\">Accommodation and Tenancy Support<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-15-field_14-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-15-field_14\">Plan management details- for self-managed please advise.\/optional <\/label><textarea id=\"wpforms-15-field_14\" class=\"wpforms-field-medium\" name=\"wpforms[fields][14]\" aria-errormessage=\"wpforms-15-field_14-error\" ><\/textarea><\/div><div id=\"wpforms-15-field_7-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"7\"><fieldset><legend class=\"wpforms-field-label\">Emergency Contact\/ optional<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-15-field_7\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][7][first]\" aria-errormessage=\"wpforms-15-field_7-error\" ><label for=\"wpforms-15-field_7\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-15-field_7-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][7][last]\" aria-errormessage=\"wpforms-15-field_7-last-error\" ><label for=\"wpforms-15-field_7-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-15-field_10-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-15-field_10\">Emergency Contacts Phone Number\/ optional<\/label><input type=\"text\" id=\"wpforms-15-field_10\" class=\"wpforms-field-medium\" name=\"wpforms[fields][10]\" aria-errormessage=\"wpforms-15-field_10-error\" ><\/div><div id=\"wpforms-15-field_3-container\" class=\"wpforms-field wpforms-field-number-slider\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-15-field_3\">How urgent is this referal <\/label>\n<input\n\ttype=\"range\"\n\tid=\"wpforms-15-field_3\" class=\"wpforms-field-medium\" name=\"wpforms[fields][3]\" value=\"0\" aria-errormessage=\"wpforms-15-field_3-error\"\t\tmin=\"0\"\n\tmax=\"10\"\n\tstep=\"1\">\n\n<div class=\"wpforms-field-number-slider-hint\"\n\tdata-hint=\"Selected Value: {value}\">\n\tSelected Value: <b>0<\/b><\/div>\n<\/div><div id=\"wpforms-15-field_9-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-15-field_9\">Anything else you want to share with me <\/label><textarea id=\"wpforms-15-field_9\" class=\"wpforms-field-medium\" name=\"wpforms[fields][9]\" aria-errormessage=\"wpforms-15-field_9-error\" ><\/textarea><\/div><div id=\"wpforms-15-field_16-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"16\"><fieldset><legend class=\"wpforms-field-label\">Plan Nominee \/ optional <\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-15-field_16\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][16][first]\" aria-errormessage=\"wpforms-15-field_16-error\" ><label for=\"wpforms-15-field_16\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-15-field_16-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][16][last]\" aria-errormessage=\"wpforms-15-field_16-last-error\" ><label for=\"wpforms-15-field_16-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-15-field_17-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-15-field_17\">Email<\/label><input type=\"email\" id=\"wpforms-15-field_17\" class=\"wpforms-field-medium\" name=\"wpforms[fields][17]\" spellcheck=\"false\" aria-errormessage=\"wpforms-15-field_17-error\" ><\/div><div id=\"wpforms-15-field_18-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-15-field_18\">Phone<\/label><input type=\"tel\" id=\"wpforms-15-field_18\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][18]\" aria-label=\"Phone\" aria-errormessage=\"wpforms-15-field_18-error\" ><\/div><div id=\"wpforms-15-field_21-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-15-field_21\">RISK OR Behaviors of concern <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-15-field_21\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][21]\" aria-errormessage=\"wpforms-15-field_21-error\" required><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"15\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/breatherecoverconnect.com.au\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F152\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-15\" class=\"wpforms-submit\" data-alt-text=\"Thank you....sending now.... \" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/breatherecoverconnect.com.au\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" 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