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headspace referral form

At headspace , we provide free and confidential mental health support for young people aged 12 to 25, delivered by qualified youth mental health professionals.

headspace Portland, 33 Otway Street, Portland, VIC 3305, 03 5561 8850

Need help now?

headspace is not an emergency service. If you or someone else is in immediate danger, please call emergency services on 000. For 24-hour mental health crisis support: 1. South West Healthcare Mental Health and Wellbeing Services - 1800 808 284 2. Present to your nearest hospital emergency department

This referral form is for headspace only. To find your closest centre, click here.

If you're looking for a different location, the following headspace centres have their own direct referral forms: Warrnambool and Hamilton. Please click the centre name to access their form.

Receipt of the referral form does not indicate acceptance to headspace services.

About the program

The headspace general mental health program offers short-term services for young people experiencing mild to moderate mental health challenges. Please note we do not provide diagnostic assessments.

Have questions or need help with this form? Please call 03 5561 8850 (Mon - Fri, 9am - 5pm).

Consent

Is the young person aware of this referral and have they consented to the referral?

I understand and accept the above information