InterLink Registration Form

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Please provide us with some details so that we can match you with the best InterLink program.

Email *

Name *

Pronouns

Phone *

What is the postcode where you live? *

Do you identify as Aboriginal and/or Torres Strait Islander?

Yes, Torres Strait Islander

Yes, Aboriginal

Yes, both Aboriginal and Torres Strait Islander

Prefer not to answer

Clear selection

Do you have a disability, and/or long-term chronic health condition?

Yes

Don't know

Prefer not to answer

Clear selection

Do you have any accessibility issues we should be mindful of?

Do you have a Medicare Card?

Yes

Other:

Clear selection

Do you have a Health Care Card or a Pensioner Concession Card?

Yes

Other:

Clear selection

Are you an NDIS Participant?

Yes

Other:

Clear selection

Do you have an intersex variation (innate variation in sex characteristic, "DSD") *

Yes

I am the parent/guardian of someone with an intersex variation

I am the partner of someone with an intersex variation

I am a sibling, grandparent or close relative of someone with an intersex variation

I am registering on behalf of someone else

Required

If you are a parent/guardian of a young person with an intersex variation or registering on behalf of someone else, who are you registering for (select all that apply)?

A young person with an intersex variation

A parent/guardian

An adult with an intersex variation

Other family members

Other:

What age groups you are registering for? *

0-9

10-13

14-17

18-25

26-60

60+

Required

What style of support are you looking for (select all that apply)?
*

Individual counselling

Family counselling

InterLink groups

Art Therapy groups

In-person

Online

Other:

Required

Have you already connected with peer support for your (your child's) intersex variation?

Yes, multiple times

Yes, once

Clear selection

Do you currently have access to a trusted mental health practitioner?

Yes

Clear selection

Is there something specific you hope to get from InterLink or is there anything else you would like to share with us at this point?

How did you find out about InterLink? (tick all that apply): *

Intersex peers

Clinical Specialist

Psychologist or counsellor

Social Worker or Case Manager

Social Media or websearch

Other:

Required

Thank you for completing this form. We will contact you soon to make an appointment where we can continue your registration.

For more information about InterLink services please contact us on 07 3017 1724 or email bonnie.hart@ihra.org.au

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