Referral Form

Online Referral Process

  1. Obtain consent – Ensure your client consents to being referred to Yorgum for counselling services.
  2. Complete the Referral Form – Ensure all sections are completed in order for Yorgum to accept the referral
  3. Submit the completed Referral Form to Yorgum.
  4. Yorgum will confirm receipt and acceptance of referral within five business days.
    • A staff member from Yorgum may contact you for additional information if required.
  5. Yorgum’s intake team will contact the individual directly to schedule an initial intake and assessment appointment.
    • If the client consents the referring agency may receive an update regarding the outcome of the referral.

Yorgum is not a crisis service.

If the individual needs immediate support, we encourage you to connect with a dedicated crisis support service for the assistance.

Referral Form