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Welcome to our online self-referral form. Please complete as much of this form as possible. Once we receive your form, we aim to respond within 72 hours. Thank you.

Please complete Section A (details of the person you are referring) and Section B (your own details as the referrer)

Once we have your form, our team will aim to contact the person you’re referring within 72 hours. Thank you.

How can we help you?

Thank you for considering leaving a gift in your Will.

To receive further information about the process and to find out how your gift could be used, please complete and return the form below. Thank you.

Please give us as much information as you can. Once we have your form, our team will aim to contact you within 72 hours. Thank you.

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Courage

We will do the right thing. Standing up for people, their rights, wellbeing and recovery

Compassion

We listen and respond with hope, kindness and respect.

Curiosity

We explore, reflect, learn and adapt to create solutions that are best for people’s wellbeing.

Collaboration

We will work with those who share our vision and values.