Health Professionals, Friends and Other Supporters – Carer Referral Form

If you are a health professional, friend or other supporter and interested in referring a carer, please complete the referral form below.
A member of the team will be in contact with the carer and/or you within 2 working days.

Carer Referral Form

Before completing this form please consider:

Is this person an unpaid carer of someone with mental health needs (i.e. not a paid support worker) as Arafmi is for mental health carers?(Required)

Do you have consent/approval from the carer to share their details with Arafmi?(Required)

Does the carer agree to Arafmi contacting them?(Required)

Is it safe to contact this person by phone, text, email or leave a message?(Required)

Write comments below(Required)

Do we need to contact you prior to contacting the carer?(Required)

Your Details:

Name (First)(Required)

Name (Last)(Required)

Phone(Required)

Organisation (if applicable)

How did you hear about Arafmi?(Required)

If you would like to refer a carer, please provide the following details.

Carer Details:

Name (First)(Required)

Name (Last)(Required)

Phone(Required)

Region (where the carer lives)(Required)

I confirm this person is an unpaid carer of someone with mental health needs (i.e. not a paid support worker)(Required)

They care for(Required)

This carer is interested in finding out more about the following carer supports and programs:

Individual carer support and coaching

Group supports

Education and workshop

Information and referrals

Respite accommodation

Wellbeing and retreats

Events

Carer Gateway programs and options for you in your local area

Not sure

Do you have any other client information or details?

What is their preferred way of being contacted (e.g. by phone) and time to be contacted?

If the carer requires an interpreter or supports please provide details below

Any additional info?

Thank you for your enquiry. A member of the team will be in contact with the carer and/or you within 2 working days.