Start support

Make a referral

Refer yourself, a family member or a participant. Our team will review the information and contact you about next steps.

Referral form

Tell us how we can help

Fields marked * are required. Please do not include highly sensitive medical documents in this first enquiry.

Your name *

Your relationship to participant *

Email *

Phone *

Participant name *

Participant age range

Suburb or service area *

Primary service requested *

Funding management

When is support needed?

Support needs, goals and preferred schedule *

I confirm I have authority or consent to make this referral and agree to be contacted about it. *

For urgent danger or a medical emergency, call 000. This form is not monitored as an emergency service.