If you are completing this form on behalf of someone please ensure you have obtained their consent.
These forms are checked once per workday (Monday-Friday, between the hours of 9am-4:30pm), if you need immediate support please contact Lifeline on 13 11 14 or if it’s an emergency call 000.
Privacy is important to us, the information on this form will be kept confidential in line with Stride privacy policy.
Some information may be shared with our Consortium Partners.
If you would prefer to complete a referral over the phone, please call your local LikeMind centre.
If you would prefer to complete a referral over the phone, please call your local LikeMind centre.