General Counselling Request Form
Please complete this form with as many details as possible. 
You do not need a doctors referral for this service.
Our counselling sessions are FREE
We have an office in BLACKTOWN, NSW  and RICHMOND for Face to Face counselling support.
Our current wait times is 2 months. If your need is urgent please reach out for other support and your GP should be able to direct you to other services.
Otherwise, please be patient as we allocate you to one of our team.
Our Counsellors will TEXT you, organise a short introduction call, advise you of the service and book your first counselling session.
Our Counsellors are all VOLUNTEERS and self funded and we receive no financial support from GOV or other entities.
Our Counsellors are qualified, registered and insured
Our Intern Counsellors are of the highest quality and also insured from most universities in Australia.
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Email *
Your Name (client) *
Your Surname (client) *
Your email address (client) *
Your contact number (client) *
Your home address (client) *
What type of support are you requiring? (client) i.e I need support with addictions and relationships. *
Delivery of Counselling Support (please select your preference) we will do our best to meet your needs (our offices are currently only located in Richmond, NSW) *
Required
REFERRER - FULL NAME 
If you are referring some to the service please complete the following (you will be advised when connection with client is made  -successfully or unsuccessfully)
 *
REFERRER - EMAIL *
REFERRER - CONTACT NUMBER *
REFERRER - ORGANISATION NAME *
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