Please complete this form to initiate referral to FSA Psychology. Following submission of this form, our administration staff will contact you within five business days to follow up your enquiry. Additional information regarding the services offered by FSA Psychology can be found at www.FSApsychology.org.au.

Please note this is a not a crisis service option. If you require more immediate support, please contact:

• Lifeline – 13 11 14
• Kids Helpline – 1800 55 1800
• Suicide Call Back Service – 1300 659 457
• Parent Line – 1300 1300 52
• Mental Health Line – 1800 011 511
• or, if experiencing an emergency call 000.

All and any information collected in this form will remain confidential to our service, except in circumstances where maintaining confidentiality jeopardises someone’s safety or breaches legal requirements. We use encrypted methods of online data collection to ensure that user information remains private and secure. Please call our office on 1800 372 000 (select option ‘2’) if you wish to speak to our admin team prior to completing this form.