Please note this form is NOT for referrers. If you are wanting to make a referral for a client please call (03) 9663 6733.

Please fill out the following form to access counselling and family services.

If you are in crisis and in need of urgent support please call Lifeline on 13 11 14.

If you are interested in attending a group or seminar please sign up here.

Please note: We do not provide the following services: Psychiatrists (can’t provide referrals), Legal Advice (we will refer you to Family Law Courts or Legal Aid), Mediation, Diagnostic assessments & Court Reports. Only provide your email if you consent to us emailing you. You WILL receive an auto receipt to this email address when you complete this form.

We are currently experiencing a high volume of registrations please allow 10 working days for us to contact you.











Residential Address is same as Postal Address







MobileHome or Work PhoneSMS & Voice mailEmail





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I declare that the information I have provided is mine and I give consent for the team at drummond street services to contact me