Let’s work together

External Referrals

If you are an external referrer—whether you're a healthcare provider, social worker, or community partner—we welcome your support in connecting individuals with the services they need. We're here to work with you and your clients to ensure they receive the care and assistance that will make a meaningful difference in their lives.

Please fill in the form below to submit a referral, or email our team directly at admin@waiukufamilysupport.co.nz if you have any questions. Together, we can make a positive impact.

Name of Referrer

First Name

Last Name

Organisation/Agency

Email

Phone

(###)

###

####

Name of Client

First Name

Last Name

Clients Phone

(###)

###

####

Client's Current Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Have you gained consent from the client?

Consent must be obtained before sharing client information with another service. This ensures the client is aware of and agrees to the referral, and understands what information will be shared.

Verbal

Written

If No, please explain why the referral is being made without client consent:

Reason for referral