To refer someone to our services, or to self-refer yourself, please complete the form below.

This referral will go to our centralised referral service where it will be assessed and assigned to the appropriate service within our organisation. If it is determined that there is no appropriate service within the organisation, it will be discussed with you further.

  • If this is for a member of your whanau, please just enter "Whanau"
  • If you are making this referral for yourself please enter your own name
  • Please tick all that apply
  • If you have no email, please record as 'No email'
  • Please enter where you live or where you can be contacted
  • Additional information will be helpful in determining the most appropriate support service.
  • Choose from one of the following (this is not compulsory)
  • This field is for validation purposes and should be left unchanged.

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