• If you are a Family or Friend referring a Young Person on their behalf, please use this Form.

    If you are a Young Person (aged 12-25) referring yourself, please use the 

    Young Person Self Referral Form

    If you are a Professional Referrer (e.g Teacher, GP, Case Worker etc), please use the

    Professional Referral Form

  • Please note; headspace Mildura is not an acute mental health/crisis service. If you have immediate concerns regarding the safety/wellbeing of the young Person, please contact Emergency Services on 000 or Mildura Base Public Hospital Mental Health Services on (03) 5022 3500

  • Referrer Contact Information 

  • Young Person's Contact Information 

  •  /  /
    Pick a Date
  • Reason for referral to headspace Mildura

  • Thank you for your referral.  A team member will be in touch with the nominated contact within the next 3 business days.

    Please note; headspace Mildura is not an acute mental health/crisis service. If you have immediate concerns regarding the safety/wellbeing of the young Person, please contact Emergency Services on 000 or Mildura Base Public Hospital Mental Health Services on (03) 5022 3500

  • Your privacy is important to us. This information will be kept confidential and used only to provide the best care possible. Please refer to:

    headspace Privacy Policy

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