Connect with us

Connect With Us

Use this form to request contact from one of our Family and Carer Peer Workers.

You will be asked your preferred contact method. You can message anytime and we’ll respond within 2 business days.

All your information is private and confidential and all information you submit on this form, is stored on a secure server.  Please ensure you read 'Your Rights and Responsibilities' document and the Privacy Statement before proceeding with this form.

We are not a crisis service. If you are concerned for your or someone else's safety, please contact 000 immediately. For 24/7 mental health support, call Lifeline on 13 11 14

I would like to refer ... *

MyselfMy client

Referral Details

Name of Referrer *

Role *

Date *

Name of service *

Email *

Phone *

Consent to share info with Connect?

Carer Details

Full Name *

Age

Postcode *

Gender

Cultural Background

Are you Aboriginal or Torres Strait Islander?

Phone *

Email *

Best time to contact

Preferred contact method *

Interpreter needed *

YesNoNot Sure

Language *

interpreter gender *

Do you have any accessibility needs?

Is there anything else you would like us to know?

First Name *

Age *

Postcode *

Gender *

Cultural Background *

Are you Aboriginal or Torres Strait Islander? *

Phone *

Email *

Best time to contact

Preferred contact method

Interpreter needed *

YesNoNot Sure

Language *

Interpreter gender *

Do you have any accessibility needs?

Is there anything else you would like us to know?

North East Metro Mental Health and Wellbeing Connect is run by the lead agency - Access Health & Community, in partnership with healthAbility  and SHARC.