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If you would like to access counselling, please express interest using the form below.

If you are in crisis and in need of urgent support, please call Lifeline on 13 11 14.

Please note: Please note this form is NOT for referrers. If you are wanting to make a referral for a client, please call (03) 9663 6733. We do not provide the following services: Psychiatrists (can’t provide referrals), Legal Advice (we will refer you to Family Law Courts or Legal Aid), Mediation, Diagnostic assessments & Court Reports. Only provide your email if you consent to us emailing you. You WILL receive an auto receipt to this email address when you complete this form.

Please allow up to seven business days for our Intake team to get back to you for an Intake session, and note that we do have waiting lists for services.

Title

First Name

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Other Gender

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Do you identify as an Aboriginal or a Torres Strait Islander?

Do any of your immediate family identify as Aboriginal or Torres Strait Islander origin?

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Will you need an interpreter?

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How well do you speak English?

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What is your annual income?

Do you hold a valid Health Care Card?

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I declare that the information I have provided is mine and I give consent for the team at drummond street services to contact me

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Queerspace is an organisation dedicated to upholding the wellbeing and mental health of Melbourne’s LGBTIQ+ community, who consist of lesbian, gay, bisexual, transgender and/or gender diverse, intersex, queer, questioning and asexual people.

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