Enquiry Form

Change Futures enquiry form for psychological services.

This form is designed for individuals seeking assistance for themselves. If you are making a referral on behalf of someone else, please use the referral form instead.

Holiday Closure:

Change Futures will be closed from 5pm Friday 19 December and will reopen on Monday 5 January. Enquiries submitted during this time will be reviewed when our team returns.

If urgent support is required during this time, please contact:

000 (immediate danger)
Lifeline 13 11 14 (24/7 crisis support)
Suicide Call Back Service 1300 659 467
QLD Acute Care – 1300 MH CALL (1300 642 255)
NSW Acute Care – 1800 011 511

Change Futures is not a crisis service.

Your Contact Information

Family Name: Given Names: Preferred Pronouns:

Return Contact Details

Phone/Mobile: Email address:

Consent

I consent to receiving a return call from Change Futures: I consent to receiving a voice message or SMS:

Service

If you are unsure what service to select, please select Private Practice.

Select a service: Region where I live:

Submission Instructions

Please finalise your submission by clicking the "Submit" button below. Thank you.

Call Us

Referral Form