Friend or Family Member
If you've been worried about someone's medication use and would like some support, or to chat about your concerns, please fill out this form.
You can also fill out this form if you'd just like more information about our services.
We will contact you within 2-3 business days. You can also call our intake worker on 1800 931 101 (9am - 5pm, Mon-Fri).
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Your Date of Birth
Your Phone Number:
Your Email Address (optional):
Are you seeking help for yourself, or someone else? (if selecting someone else, please ask them to call us on 1800 931 101)
Your relationship to the person you are concerned about:
Their sibling (brother/sister)
Another family member
Tell us a little bit about your concerns/ what kind of support you're looking for:
Do you require an interpreter?
How did you hear about us?
If you are in crisis or need urgent or after hours support, please contact one of these services:
Emergency services: 000
Directline: 1800 888 236
Family Drug Help: 1300 660 068
Lifeline: 13 11 14
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