Self Referral
To find out more about the Medication Support and Recovery Service, or make an appointment, please fill in the self referral form below and we will contact you within 2-3 business days.

You can also call us on 1800 931 101 (9am - 5pm, Mon-Fri) to speak to our intake worker.

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Your Name: *
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Your Contact Number: *
Your Email Address (optional):
Your Date of Birth: *
Suburb or postcode where you currently live: *
What medications are you concerned about?
Do you have anyone else supporting you at the moment?
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When is the best time for us to call you? Is it ok for us to leave a voicemail if we can't reach you?
Do you require an interpreter?
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How did you hear about us? *
Thanks for getting in touch. We will contact you within 2-3 business days.               If you are in crisis or need urgent or after hours help, please contact one of these services:
Emergency services: 000

Lifeline: 13 11 14

Directline: 1800 888 236

Nurse on Call: 1300 60 60 24
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