Referral Form

If you are interested in accessing one of our services and would like to know if we are best placed to support you with your mental health needs, you can refer yourself using this form. You don't need to wait for a healthcare professional to refer you - you can take the first step yourself.

The form includes fields for your personal information, such as your name, contact information, and the support you require. We'll use this information to better understand your needs and to match you with a psychologist.

For GPs: If you are a health professional, you can use the form to submit a referral, or alternatively fax your referral through to 088 330 6144. For enquiries, you are welcome to contact us on 0481 614 797.