Referral Assessment Form

Emergency Numbers

Ministry of Health Crisis Assessment Teams:

Lifeline Helpline

0800 543 354

Lifeline Crisis Line

Suicide Crisis Helpline
0508 828 865 (0508 TAUTOKO) 

THIS FORM IS CONFIDENTIAL  

Please send me a text confirming that you have submitted a referral 027 349 9937 - Please add date, time and your name.

Please provide details re the referral below. 

Thank you for contacting us. We will get back to you as soon as possible
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