Counselling Referral Form

If you do not have dependent children under the age of 25, you are unfortunately not eligible for this service. If you would like to discuss this further, please contact the counselling team on (08) 9261 4498 for more information.

If the child is not aged between 6 and 25, they are unfortunately not eligible for this service. If you would like to discuss this further, please contact the counselling team on (08) 9261 4498 for more information.

If NO, please do not complete this form and contact the office on 9261 4498 or email counselling@lifelinewa.org.au.

So that our counsellors can best support you or your friend/family member/client, please answer the following questions as well as you can.

Please note that Lifeline WA's Counselling Services have a 24-hour cancellation policy.