Please complete this form and return it, along with a copy of the care plan, safety plan and/ or assessment summary (if available). A team member from Universal Aftercare South West QLD may follow up with you if more information is required to assess suitability or eligibility for the service. If they are deemed eligible, a Support Coordinator from Universal Aftercare South West QLD will contact the person being referred. Please ensure a consent form has been completed for each referral to avoid any delays.

To be eligible for Universal Aftercare South West QLD, the consumer must meet the following criteria:

• Currently in hospital due to a suicide attempt or currently experiencing a suicidal crisis, experiencing distress or suicidal thoughts, and articulating an intent to die.
• Is over 15 years old.
• Consent to this referral is being made.
• Referred by South West Hospital and Health Services, GP’s, Lifeline Western Sector, Goondir, CACH, or  CWAATSICH.
• Living in the following areas: South West regions including Quilpie, Murweh, Maranoa, Bulloo, Paroo or Balonne Shire Local Government Areas (LGA’s).