Referral Form

"*" indicates required fields

DD slash MM slash YYYY

DD slash MM slash YYYY
Self-Referral*
Is the client / guardian aware?
Has consent been given for this referral?

Important information to consider

  • The reporting of domestic and family violence is everyone’s business. Should you feel your client and family are at immediate risk OR your concerned for your clients Wellbeing, please report concerns

Ambulance – 000

Police – 000/131444

MHATT 24hour Northern Territory Mental Health Hotline 1800662288

  • If you feel that your client would benefit from seeking urgent assistance to address significant but not imminent risk to self or others, please encourage/assist  client to attend Wurli Health Service for review by GP
  • Wurli Community Services can offer support and advice during moments of crisis and strongly encourage clients, family, and organisation to contact the service with their concerns for advice.