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Online Referrals

Bravehearts Support Services Referral Form


    Please complete ONE form per client
    *This question will help us to ensure we are calling our client by their preferred pronoun.
  • *If No, please be advised all Bravehearts' Consent Forms can only be completed and signed by the child's Legal Guardian.
  • *When working with children and young people therapeutically, Bravehearts believes strongly in a holistic family approach. In order to achieve the best outcomes for the child and the family, Bravehearts recommends the parent(s)/caregiver(s) also engage in our therapeutic services for education and support.
  • *Bravehearts eHealth is an online, fully confidential, video conferencing counselling, case management and support platform.
  • If yes, please provide details of each service and what support is being accessed.

  • What prompted your referral of this client to Bravehearts, and how would you like us to support this client?
  • Drop files here or
    Accepted file types: pdf, jpg, png.
  • For the protection of the client's privacy, both now and in the future, if you have any other clients requesting support, please complete one Referral Form per client.