Alternatives to Suicide Referral Form

alt2su is a peer led, non-clinical and confidential space where people can talk about, sit with and make sense of suicidal experiences, thoughts and distress.

Together we find strength & healing in collective wisdom and the sharing of stories.

First Name *

Last Name *

Postcode *

Phone *

Email Address *

DOB *

Gender

Pronoun/s

Do you identify as LGBTQIAP+

Do you identify as Culturally or linguistically diverse

Do you identify as having a disability

Do you identify as Aboriginal or Torres Strait Islander

Are you completing this form on behalf of someone you are supporting? *

YesNo

Do you have the consent of the person you are supporting to complete this referral, and for Brook RED to contact them? *

YesNo

Preferred Contact *

Phone callTextEmail

Brook RED offers a safe, welcoming, and recovery-focused environment, and we ask that all individuals accessing our groups contribute positively to our community.

Is there anything else you would like us to know?

Date: *

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