Quick Exit

Children and Families Counselling referral form

This form is for the use of professionals or carers. For self-referrals please phone us (03) 6231 0044 during business hours for direct support from our friendly team.

If you have experienced sexual violence or harm in the past 7 days, please call the SASS 24/7 Helpline (1800 697 877) for immediate information and support.

PDF referral

Upload your completed PDF referral form via the secure portal. For security reasons, do not send the referral form via email.

Online referral

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