I am a professional making a referral for a young person who is aged between 12 and 25

Please be aware that we are currently experiencing a high demand for our counselling service resulting in extended wait-times.

Privacy Statement

Counselling is a private and confidential service. The personal and health information is being collected by Council for the purposes of counselling. This information will be stored in Council’s Customer Database and used to identify the client when communicating with Council and for Council to deliver services and information to the client. We will ensure that the personal information is not disclosed to other individuals, institutions, and authorities outside Council except if required or authorised by law or clear informed consent is given.

The personal information will be handled in accordance with the Privacy and Data Protection Act 2014 (Vic). For further information on how the personal and health information will be handled please refer to Council’s Privacy Policy

In order for us to provide this young person with the most suitable support, please fill all the required sections in this form.
Is the young person a resident, studying, working, or recreating in Wyndham? (required)

Wyndham Youth Counselling Services prioritises young people and their families who live, work, study or recreate in Wyndham. This means that your young person may not be eligible to access our service. However, you are more than welcome to  give us a call on 87341355 to have a chat with one of our Youth Counsellors, send an email to YouthCounselling@wyndham.vic.gov.au or visit us at any of the locations listed below to get  more information about our services:

Youth Services @ Hoppers Crossing - 86 Derrimut Road, Hoppers Crossing

Youth Services @ Point Cook - 1-21 Cheetham Street, Point Cook

Youth Services @ Tarneit - 150 Sunset Views Boulevard, Tarneit

Youth Services @ Manor Lakes - 86 Manor Lakes Boulevard, Manor Lakes

Please select if any of the below applies to your young person. (required)

BASED ON THE INFORMATION YOU HAVE PROVIDED; OUR SERVICE IS NOT SUITABLE FOR THE YOUNG PERSON. PLEASE SEE RECOMMENDED SERVICE BELOW. IF YOU WISH TO DISCUSS FURTHER, PLEASE CONTACT THE COUNSELLING TEAM ON 8734 1355

Recent Sexual Assault: Please contact West Casa on 1800 806 292 or www.westcasa.org.au or Gatehouse on 9345 6391 or www.rch.org.au/gatehouse/contact/contact_us/ to make a referral into counselling services')

BASED ON THE INFORMATION YOU HAVE PROVIDED, UNFORTUNATELY, OUR SERVICE IS NOT SUITABLE FOR THE YOUNG PERSON. PLEASE SEE RECOMMENDED SERVICE BELOW. IF YOU WISH TO DISCUSS FURTHER, PLEASE CONTACT THE COUNSELLING TEAM ON 8734 1355

The Orange Door Western Melbourne on 1800 271 045 or in person at 15-17 Watton Street, Werribee 3030. For further information visit their website https://www.orangedoor.vic.gov.au/

BASED ON THE INFORMATION YOU HAVE PROVIDED; OUR SERVICE MAY NOT BE SUITABLE FOR THE YOUNG PERSON. YOU ARE WELCOME TO COMPLETE THIS FORM BUT PLEASE SEE THE RECOMMENDED SERVICE BELOW FOR MORE TAILORED AND SPECIALISED SUPPORT. IF YOU WISH TO DISCUSS FURTHER, PLEASE CONTACT THE COUNSELLING TEAM ON 8734 1355

Victims of Crime Helpline (Open 8am-11pm every day)

BASED ON THE INFORMATION YOU HAVE PROVIDED; OUR SERVICE MAY NOT BE SUITABLE FOR THE YOUNG PERSON. HOWEVER, YOU ARE WELCOME TO COMPLETE THIS FORM IF YOU BELIEVE THE YOUNG PRSON WOULD STILL BENEFIT FROM OUR SERVICE. IF YOU WISH TO DISCUSS FURTHER, PLEASE CONTACT THE COUNSELLING TEAM ON 8734 1355

Please be aware that our service is not suitable for children diagnosed with developmental conditions requiring specialist support and treatment. Please refer your client to GP or refer to NDIS website further information https://www.ndis.gov.au/

BASED ON WHAT YOU'VE TOLD US, OUR SERVICE MIGHT NOT BE THE BEST FIT FOR YOUR YOUNG PERSON BECAUSE WE DO NOT SPECIALISE IN SUPPORTING YOUNG PEOPLE WHO ARE AFFECTED BY SERIOUS MENTAL HEALTH CONDITIONS. WE SUGGEST SEEKING ASSISTANCE FROM A MORE APPROPRIATE SERVICE. HOWEVER, YOU CAN STILL SUBMIT THIS FORM. IF YOU HAVE ANY QUESTIONS OR WANT TO DISCUSS THIS FURTHER, PLEASE REACH OUT TO OUR COUNSELLING TEAM AT 8734 1355. YOU CAN CONTACT THE SERVICES BELOW TO ACCESS A MORE SPECIALISED SERVICE:

Local Youth Mental Health Service Headspace to discuss options (03) 8001 2366 https://headspace.org.au/headspace-centres/werribee/

Psychiatric triage (information, assessment, and referral)

Business hours (9:00am to 5:00pm, Monday to Friday)

For Under 15 years: Telephone: 1800 445 511

For 15+ years: Telephone: 1800 888 320

PLEASE BE AWARE THAT WE ARE NOT AN EMERGENCY OR CRISIS SERVICE OR ABLE TO PROVIDE SPECIALIST PSYCHIATRIC CARE. BASED ON THE INFORMATION YOU HAVE PROVIDED; OUR SERVICE IS NOT SUITABLE FOR THE YOUG PERSON. IF THE YOUNG PERSON IS IN AN EMERGENCY CALL TRIPLE ZERO NOW (000).

If the young person is feeling overwhelmed and need to speak with someone immediately, they can contact:

  • Lifeline on 13 11 14
  • Kid help line (for 5–25-year-olds) 1800 55 1800
Young person's details
Parent/Carer/Legal Guardian details
Is the parent aware of this referral (required)

The parent/carer/legal guardian will not be contacted if they are not aware of this referral. In addition, parents are only contacted when young people are under the age of 18 years if required.

Parent/Carer/Legal Guardian Details (2nd person, if applicable)
Referrer Details
Emergency contact
Is the emergency contact the same as the referrer? (required)
Is the emergency contact aware of the referral? (required)

Please inform the young person that in the event we are concerned about their safety or the safety of someone else, this listed emergency contact will be notified to help keep them safe. If you have concerns about the emergency contact’s ability to keep the client safe or if the client does not want that contact to be notified, they should nominate another responsible adult in their life that is available to provide support.

If you aren’t able to provide all of this information, please call Youth Services on 8734 1355 for help to complete this form.

Please be advised that we are not a crisis or emergency service, and it may take some time for us to respond to your requests. If you would like to know about the crisis and support services available in Wyndham, visit the Support Services webpage.

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