I am aged between 12 and 25 and I want counselling support for myself

Please be aware that we are currently experiencing a high demand for our counselling service resulting in extended wait-times.

PRIVACY STATEMENT

Counselling is a private and confidential service. The personal and health information is being collected by Council for the purposes of counselling. This information will be stored in Council’s Customer Database and used to identify the client when communicating with Council and for Council to deliver services and information to the client. We will ensure that the personal information is not disclosed to other individuals, institutions, and authorities outside Council except if required or authorised by law or clear informed consent is given.

The personal information will be handled in accordance with the Privacy and Data Protection Act 2014 (Vic). For further information on how the personal and health information will be handled please refer to Council’s Privacy Policy

In order for us to provide you with the most suitable support, we need you to answer a few questions and give us some information about your circumstances:

Are you a resident, studying, working, or recreating in Wyndham?

Yes

Wyndham Youth Counselling Services prioritises young people who live, work, study or recreate in Wyndham. This means that you may not be eligible to access to our service. However, you are more than welcome to complete this form and we will get in touch with you to see how we can help.

Your details

Given Name (required)

Family/Surname (required)

Preferred Name

Date of Birth (required)

Gender

Address

Email Address (required)

Contact Number(required)

Emergency Contact Details

Given Name (required)

Family/Surname (required)

Contact Number(required)

Relationship to you (e.g. parent, carer, legal guardian, responsible adult) (required)

Is this emergency contact aware of referral? (required)

Yes

Please note that if we are concerned about your safety or the safety of someone else, we may need to notify this emergency contact to keep you or someone else safe. If you do not want that contact to be notified, you should nominate another responsible adult in your life who is available to provide support to you.

Name of your school (Optional) - Please note that we will not contact your school without your consent unless required by law

Tell us briefly why you need counselling and what you are hoping to achieve from your engagement with our service: (required)

Do you have any specific needs in order to access counselling? (Disability, interpreter, cultural or religious needs etc.) (required)

I understand that if I or someone else is in immediate danger that I need to contact emergency services on 000. You can contact the following services if you are in a crisis and need immediate support: Kids Helpline: 1800 551 800 Headspace: 1800 650 890 (required)

We will do our best to process your request, but it may take up to three or more days. If you have any questions or need assistance, please don’t hesitate to contact us at 8734 1355 to speak with one of our youth counsellors, send an email to YouthCounselling@wyndham.vic.gov.au, or visit any of the following locations for more information about our services:

Youth Services @ Hoppers Crossing: 86 Derrimut Road, Hoppers Crossing
Youth Services @ Point Cook: 1-21 Cheetham Street, Point Cook
Youth Services @ Tarneit: 150 Sunset Views Boulevard, Tarneit
Youth Services @ Manor Lakes: 86 Manor Lakes Boulevard, Manor Lakes"

If you would like to know about the other support services available in Wyndham visit the Support Services webpage.

I am aged between 12 and 25 and I want counselling support for myself

Acknowledgement of Traditional Custodians