Working together

Make a referral

Tell us about the support you or someone you care for needs. Our team will review your referral and contact you about next steps.

This form is not monitored for emergencies. If someone is in immediate danger, call 000.

Person needing support

First name

Last name

Contact email

Contact phone (optional)

For a child, you can provide their parent or guardian’s contact details.

Support or service requested (optional)

How can we help?

A short summary is enough. Please don’t include Medicare or NDIS numbers, or detailed medical records. Up to 2,000 characters.

About the person submitting

I am referring

Your information

These details are sent securely to Yellow Balloon Therapy’s practice system for staff to review. They are not sent to the website’s AI assistant. Submitting a referral does not create a client account or confirm an appointment. Contact the practice with questions about your information.

I agree to Yellow Balloon Therapy storing these details to review this referral and contact me. If referring someone else, I confirm I have permission to share their details.

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Call 0413 970 965 Email the practice