Refer a client

Support coordinators, health professionals and community workers can use this form to start a conversation about support.

Consent comes first

Please make sure the person knows about and agrees to the referral. If they would prefer to contact us themselves, send them to the request support page.

Privacy collection notice

Only provide the information needed for us to make contact. Please do not include diagnoses, medication details, or identity document numbers.

We collect the referrer's details, the participant's first name and contact details, plan management type, supports sought, notes and the consent declaration. We use this information to contact the referred person and assess the next step. Referral enquiries that do not progress are retained for up to 24 months. We send the referred person an APP 5 collection notice where an email is supplied, or queue it for the Director to provide where it is not. Read our Privacy Policy.

If supplied, the privacy collection notice will be emailed automatically.

Only include what we need to make first contact.