Submit Referrals Online Here to Our Mental Health Programs

I’m an individual looking for support

I’m a health professional referring a patient

Help is just a call away:

Referral Form

Complete the form below and we’ll connect you with a team member who will work with you to provide an appropriate evidence-based program.

Referring method

I am referring myself

I am referring a client

Client's Full name

Client's Date of birth

Client's Phone No

Client's Email

Region

Town / suburb

Referring Professional's Details

I acknowledge and confirm that I have discussed this referral with the client and they have consented to the referral being made.

Consent given

If you are human, leave this field blank.

If you’re a health professional, download the printable (PDF) referral form and post or email this back to us.