Request a Call Back

Please complete the details below for an ADIS counsellor to call you.

Do you identify as Aboriginal or Torres Strait Islander?
Do you require an interpreter
Day preference for call
Time preference for call
Services for referral

Referrers will need to receive verbal consent from the person named on the form prior to sending the form to Adis.

1. Referrer information

Would you like a copy of this email referral email to you?

2. Client information

Has the client consented to the referral?
Is it safe to announce we are calling from adis?
Is it safe for adis to leave a message?
Does client identify as Aboriginal or Torres Strait Islander?
Does the client require an interpreter?
Day preference for call
Time preference for call
Services for referral