Referral INFO & Form 

 

In the event of an emergency please call 000

Other Resources:

  • Link 2 Home 1800 152 152
  • Lifeline 13 11 14
  • Suicide Call Back Service 1300 659 467
  • Beyond Blue 1300 224 636
  • Mental Health Info Line 1300 794 991
  • Domestic Violence Line 1300 656 463

Complete this referral form online or phone us on 02 9330 9999 for more information. 

*Indicates a required field

 

I am referring myself to PIR
I am referring someone who has provided their verbal consent for their information to be shared with PIR
I am referring someone who is not aware of the referral or they have not given consent for their information to be shared -please phone to discuss referral
 

         

 

Yes

No

Yes

No

Actual

Estimated

DOB unknown

 

Female

Male

Intersex or Indeterminate

Unknown

Yes

No

Yes

No

Yes

No, click here to skip to next section



Yes

No

Yes

No

Unknown

Yes

No

Yes

No

Yes

No

Yes

No

Unknown

Yes

No

Unknown

Formal

Informal

Unknown

Co-resident

Non-resident

No

Unknown

Mental Health History

Yes

No

Unknown

Public Mental Health Service

Private Psychiatrist

General Practitioner

Other Private Mental Health Practitioner

Unknown

No

Yes

No

 

Yes

No

Unknown

Yes

No

Unknown

Yes

No

Unknown

Yes

No

Unknown

Yes

No

Unknown

 Physical health concerns

 Physical disability

 Aquired brain injury

 Intellectual or Cognitive disability

 Dementia

 Drug and Alcohol abuse

 Sensory or Speech disability

 Other

 No apparent co-existing factors

Current Supports

Yes

No

Unknown

Yes

No

Unknown

Yes

No

Unknown

Female Support Facilitator

Male Support Facilitator

First available Support Facilitator

Income

Yes

No

Unknown

Yes

No

Unknown

Living Arrangements

Yes

No

Unknown

Notes or comments relating to this referral

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How do i refer?

Anyone can refer to Partners in Recovery. Just click the button below!

Refer to us Online
More Information

For more information, download our PDF brochure.

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Click here to visit our Useful Links Or click here to visit our Useful Links
Meet Debbie
PIR Consumer Meet Debbie

"I'm focusing and a lot of things have been put in place for me to look forward to and for me to do. I focus on what I can do and what I can accomplish. My depression has improved a lot."

Meet Gavin
PIR consumer Meet Gavin

"Participating in PIR has changed my life because I am having people take notice of me, and what my needs are. Being able to succeed in what I want to do is important. Since PIR has come along, I am actually succeeding in what I want to do."

Meet Trudi
PIR Consumer Meet Trudi

"I have people I can contact and people available to me that I didn’t know existed. I always thought there were only one or two services out there that could help me but Matthew (my Support Facilitator) gave me a whole list."

Working With PIR
Sutherland Shire Community Services Working With PIR

"When working with consumers who are homeless and suffering with mental ill-health it is so important to have a flexible approach in order best meet their needs. We are very appreciative of PIR staff coming to our Tuesday breakfast program each week where they have become very well known to our consumers who are often happy to now self-refer and address problems with PIR before it becomes a huge issue."

In partnership with: Central and Eastern Sydney PHN After Care Benevolent Society Neami National