• OutLine counselling referral request

  • Note: OutLine's counselling coordinator will be away from 24 January until 7 February. There will be a delay responding to any counselling requests received during this period.
    If you need immediate support,
    Free call or text 1737 any time for support from a trained counsellor.
    Lifeline – 0800 543 354 (0800 LIFELINE) or free text 4357 (HELP).
    Suicide Crisis Helpline – 0508 828 865 (0508 TAUTOKO).
    Anxiety NZ – 0800 269 4389 (0800 ANXIETY).

    OutLine Aotearoa offers a face to face counselling service that is affirming of diverse sexuality and gender identities.

    Please note - this is not a crisis or emergency counselling service. If you need help now, call 1737 to talk to a trained counsellor. Always dial 111 if you (or someone else) is in immediate danger.

    In-person sessions are available in central Auckland, with video counselling  options (e.g. Skype, Zoom) available nationally. Find out more about OutLine's counselling services on our website.

    As part of assessing your referral, OutLine will discuss with you payment for services. We have a scale from $80 to $120 dependant on ability to pay, and in some cases are able to support your application to Work and Income Disability Allowance to cover the cost of sessions or offer alternative subsidised options.

    You can indicate what funding support you might need as part of this referral form.

    For more information about how we collect and use your personal information, including the information in this form, please refer to the OutLine Privacy Policy


  • Please complete the rest of this form as though you are the person to be referred for counselling.


  • Adult contact person

    For young people under 16, we also need the contact details for an appropriate adult, who we will contact alongside the young person. We want this to be someone that feels safe to have us contact, and could be a parent/guardian or health worker. Our counsellors will also need to have certain permissions from a parent/guardian of young people in this age group. 
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  • Please note - this is not a crisis or emergency counselling service. If you need help now, call 1737 to talk to a trained counsellor. Always dial 111 if you (or someone else) is in immediate danger.

  • Emergency contact

    Note that as part of the assessment before starting counselling, we'll need  contact details for an emergency contact person for you.

  • Note that you'll need to provide either a phone number or email address before you can submit this request!

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