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Mental Health Services

SERVICE REQUEST FORM

Name

First Name

Last Name

Phone

Email

Consultation Request

Are you seeking support for yourself or someone you care for? What is your age? Are you seeking mental health or eating disorder care? Do you have a GP referral? Where are you located?

Confirmation

I confirm and consent for contact to be made from Empowered Minds using these contact details.

Professional Services

SERVICE REQUEST FORM

Name

First Name

Last Name

Phone

Email

Consultation Request

Are you an Accredited Mental Health Social Worker, Social Worker working towards mental health credentialing, non-clinical Social Worker, Social Work Student? Where are you located?

Empowered Minds, Wellness & Consultancy is NOT a crisis service.

If you're experiencing an emergency, please contact EMERGENCY SERVICES 000, Mental Health Triage 13 14 65 or visit your local emergency department.

You can also contact one of these short term phone/online services (Australia only, all available 24/7):

Kids Helpline - 1800 55 1800. Support for young people.
Lifeline - 13 11 14. Support for people who are feeling overwhelmed or struggling to keep safe.
Beyond Blue - 1300 22 4636. Support for people struggling with anxiety, depression, or thoughts of suicide.
1800RESPECT - 1800 737 732. Support for those impacted by sexual assualt or domestic violence.
Butterfly Foundation - 1800 33 4673. Support for people struggling with an eating disorder or body image issues.
Mensline - 1300 78 99 78. Support for men.