This online referral form is designed primarily for health professionals who wish to refer an individual or family to our service for ongoing support and counselling. On completion of this form, a member of our intake team will contact the individual or family to explain our services and offer support. Please ensure that the individual/family referred for support has given their permission to be contacted by a member of our intake team.

If you are not a health professional, please call 1300 308 307 to access support.