LikeMind Referral Form

This form is for healthcare professionals and referrers, as well as for individuals and their family and friends, to request support from LikeMind Orange or LikeMind Wagga Wagga.

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.

• LikeMind Orange Consortium Partners:
  Local Health District, Interrelate, Lives Lived Well, Housingplus, OCTEC, Mission Australia, Marathon Health, Orange Aboriginal Medical Service and/or CatholicCare
• LikeMind Wagga Wagga Consortium Partners:
  Community Mental Health, Sunflower House, Red Cross, Murrumbidgee Primary Health Network, Personnel Group, Calvary Drug & Alcohol

If you would prefer to complete a referral over the phone, please call your local LikeMind centre.