Mental Health Service Navigation South West Sydney

Please make sure all information is completed for both Referrer and Person

Eligibility Criteria

Please tick in the Boxes:

Live in South Western Sydney Region*

Experience mental health challenges*

Which services do you need help connecting to?

Has the Person given permission to have the referral made on their behalf?

** - required

Yes

Personal Details

Full Name*

DOB*

Gender Identity

Phone*

Can we leave a voicemail on the number provided?

Yes

Current Address

Postcode*

State

Identify as:

Aboriginal

Torres Strait Islander

Culturally and Linguistically Diverse

LGBTIQA+

Language Spoken at Home

Interpreter Required

Yes

Referrer's Details

Name

Organisation Name

Address

Position or relationship to Individual

Phone

File Upload

We appreciate you taking the time to fill in this form, our Intake Officer will be in contact with you shortly. However, if you need to speak to someone about this service please contact 1800 843 539.

This service has been made possible by funding from the South Western Sydney Primary Health Network.

Mandatory field(s) marked with *