AOD Counselling
(Greymouth based)

Who is making this referral?

Name:

Company name (If Applicable)

What is your Email?

What is your best contact number?

Please provide a reason for this referral and any information that may help us understand how we can help the person being referred.

The person being referred has consented to this referral

The person being Referred to recieve therapy

First name

Last name

Email (Parents email if under 16)

Phone (Parents Phone if under 16)

Address

Date of Birth

Is this person open to receiving counselling?

Yes

Hesitant

Please explain in your own words why counselling in needed ?

If the person being referred is under 16 please provide names and contact details for parents below.

The person being referred has consented to the referral. AND if the person being referred is under 16 they have parental consent.

Family Start operates a counselling service for those impacted by alcohol or other drugs. This is only available while funding lasts. We have multiple therapists available that are DAPAANZ qualified.

Currently we offer 6 free sessions.

AOD Counselling (Greymouth based)

The person being Referred to recieve therapy

AOD Counselling
(Greymouth based)