To refer a client to see one of our counsellors, or to refer yourself, please complete the following form and click on "Submit". One of our counsellors will contact either you or the client as soon as possible. Unfortunately, referrals cannot be made by family or friends.
PLEASE NOTE:
Due to demands on our service, there is currently a wait list to see our counsellors (up to 6 months). Although we cannot currently give you an indication of when your appointment may be, we are endeavouring to see clients as quickly as possible. We thank you for your patience.
If you are unable to wait for an appointment, please contact a local GP who does mental health plans. Please be aware that not all GPs do mental health plans. They can then refer you to a psychologist through the medicare scheme.
If your need is urgent (you or the client are in crisis) please contact:
- Lifeline 13 11 14 (24 hours, 7 days)
- Crisis Care 9223 1111 or 1800 199 008
- Mental Health Emergency Response Line
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Perth Metro Residents: |
1300 555 788 |
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Peel Residents: |
1800 676 822 |
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Rural Link (AH and weekends) |
1800 552 002 |
- Armadale Mental Health Service 9391 2000 or go to Armadale Kelmscott Hospital 3056 Albany Hwy, Armadale
Referral Form |
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Name of Person Being Referred (Client) |
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Date of Birth |
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| Street Address |
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Email Address
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| Contact Phone Numbers (Client) |
Home |
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| Work |
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| Mobile |
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Is Client Pregnant?
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if yes, how many weeks?
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Does the Client have Children?
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if yes, how old are they?
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| For privacy reasons is it ok for the Counsellor to leave a message on these numbers, send you a letter or an email? |
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Details
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| Contact Phone Numbers (Referrer) |
Home |
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| Work |
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| Mobile |
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| Reason for seeing counsellor (as much information as you are comfortable with) |
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Has the person been given a specific diagnosis by a GP, Psychologist etc? If so, please give details.
Diagnosis
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PLEASE NOTE:
Due to demands on our service, there is currently a wait list to see our counsellors (up to 3 months). Although we cannot currently give you an indication of when your appointment may be, we are endeavouring to see clients as quickly as possible. We thank you for your patience.
If you are unable to wait for an appointment, please contact a local GP who does mental health plans. Please be aware that not all GPs do mental health plans. They can then refer you to a psychologist through the medicare scheme.
If your need is urgent (you or the client are in crisis) please contact:
- Lifeline 13 11 14 (24 hours, 7 days)
- Crisis Care 9223 1111 or 1800 199 008
- Mental Health Emergency Response Line 9224 8888 (all hours) or 1800 676 822 (rural free call)
- Armadale Mental Health Service 1300 555 788 or go to Armadale Kelmscott Hospital 3056 Albany Hwy, Armadale
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