Health professionals

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Your request is confidential

Our confidential services are delivered in a number of metropolitan and regional areas across Western Australia by experienced psychologists, counsellors and mental health professionals.

Request support for a young person

I am a:

Referrer's Details

Young Person's Details

Young person's location
Referral has been discussed with the young person, and they have provided their consent?
Referral has been discussed with the carers/parents of the young person and they have provided their consent?

Reason for Referral

Presenting issues (tick all relevant boxes)

Risk

Is the parent or guardian aware?
Are you aware of any other safety concerns for this young person? (e.g. risk of harm from or to others?)

Previous / Current Support

Has the young person had counselling before?
Are they engaged in any other support for their presenting issues?