Skylight Online Videos
About Us
Our Services
NDIS
Support Skylight
- Donate
- Membership
Forums
- Lived Experience Forum
- Carers Forum

Counselling Referral Form.

Thank you for considering Skylight Mental Health as your counselling provider. To get started, there’s a little bit of information we’d like to know about you in order to prepare for our work together.

If you have any questions or would like some support in filling out this form, please call Skylight Mental Health on (08) 8378 4100 to speak with a member of our Customer Relations Team.

Who is making this referral?*

I am referring myself

I am referring someone else

Referrer details:

Referrer Full Name:*

Referrer Phone Number:*

Relationship to participant:*

Referrer Email:*

Counselling participant details:

First Name:*

Last Name:*

Phone number:*

Address:*

Postcode:*

Date of birth:*

Gender:

Pronouns

Suburb:*

Email address:*

What is your preferred communication method?

Phone call

Back Next

Do you require an interpreter?*

Yes

What language?*

How would you like to access Counselling?*

NDIS Plan

Fee for Service

Mental Health Care Plan

Free service

How did you hear about Skylight?*

Which other way did you hear about us?*

Do you have a current Mental Health Care Plan and referral?*

Yes

Back Next

Please briefly describe some of the current challenges you face that make you want to come to counselling - e.g. anxiety, flashbacks, overwhelming emotions, etc.*

Back Next

What are you hoping to get out of counselling, what are your goals?*

Back Next

Is there anything else you think would be important for us to know?*

Back Next

Thank you for completing Skylight's Counselling Referral Form, please click "Submit Referral" below. You will receive a confirmation email shortly. Remember to check your spam/junk folder.

Submit Referral

Back Next

Address:
5 Cooke Terrace
Wayville SA 5034
Phone: (08) 8378 4100
ABN: 85 595 741 081

About Us

About Us
Locations
Positions Vacant
Contact Us
Our Management
Our Board
Annual Reports
Service Standards
Privacy

Information

NDIS FAQ's
Reconciliation Action Plan
Donate Now
Short Breaks EOI
Counselling Referral Form
Plan Management EOI
Therapeutic Groups EOI

Sign up to Skylight Updates!

Thank you! Please check your email and confirm the newsletter subscription.

Your subscription was updated

Email *

It seems that you have already subscribed to this list. Click here to update your profile.

First Name

Last Name

Skylight respectfully acknowledges Aboriginal people as the traditional custodians

of South Australia and celebrates all people who call this land home

Counselling Referral Form.

Referrer details:

Counselling participant details:

Follow Us

About Us

Information

Sign up to Skylight Updates!

Search