Self-referral form for specialist refugee mental health services
You can fill in this form on your own, or a support person can help you.
This is not a crisis service. If you are in immediate danger please call 111. We offer counselling to people from a refugee background who suffer from psychological symptoms from having experienced or witnessed torture or traumatic events before to coming to New Zealand.
Please complete this form with as much information as possible. Fields marked with * are required.