Welcome to Our Formal Referral System

On Country Care accepts formal referrals from the Department of Communities and Justice, community organisations, agencies and approved service partners.

To help protect client privacy, this form only collects referrer details. Any client or family information should be included within the supporting referral documents you upload.

Please only upload documents you are authorised to share with On Country Care for the purpose of referral assessment, service enquiry or support coordination.

Referrer’s Full Name*

Organisation / Agency*

Role / position*

Contact Number*

Reference / Case Number*

Email*

Additional notes (optional)

Upload Referral Documents:* Upload a file or drag and drop. doc, docx, jpg, jpeg, jpe, png, pdf up to 10MB

I confirm I am authorised to share this information with On Country Care for the purpose of referral assessment, service enquiry or support coordination.

You can also read our full Privacy Policy Here for more information about how referral information and uploaded documents are handled.