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Free wellbeing support for young people aged 12-24 living in Counties Manukau DHB

Waypoint Introduction – Short Form

Please fill in the details below.

Please note: Waypoint and our Service Providers are not emergency services and do not provide crisis support. In case of emergency, please call 111 for support. For mental health crisis phone numbers, click here.

Referrer's Full Name

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Referrer's Organisation and Title

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Referrer's Email Address

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Referrer's Mobile Number

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Client Information: Name

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Last Name

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Preferred Name & Pronoun

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Date of Birth

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NHI (if available)

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Home Address

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Contact Number

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Email

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Ethnicity

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Emergency Contact: Name, Mobile number, Relationship?

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GP Details (if available)

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Does the Young Person Consent to Waypoint having their details?

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Does the Young Person know we will contact them directly?

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Do you already have Waypoint Services in mind for the Young Person? Visit our website for a list of the services we provide. See 'How we can help' button below this form.

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About your Young Person: i.e, 5 P’s: Predisposing, Precipitating, Perpetuating, Protective and Presenting

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Current and immediate risk factors

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Address

Message Sent.

How we can help

Get in touch

askme@waypoint.org.nz

0800 WAYPOINT
0800 9297 6468

Hours
Monday to Friday
8:30am - 4:30pm