Service Referral Form
Use this form to refer someone to Mossman Support Services — whether you are a health professional, support coordinator, community worker, or referring yourself or a family member.
Referrals are welcome from everyone
You do not need to be a professional to refer someone to our services. We welcome referrals from workers, carers, family members and from people referring themselves.
Professional Referrers
If you are working with someone who would benefit from our lifestyle support, disability, family or community services — we'd love to hear from you.
- GPs, allied health and medical professionals
- NDIS support coordinators and plan managers
- Social workers and case managers
- Hospital discharge planners
- Teachers, school counsellors and youth workers
- Other community service providers
- Queensland Health and government agencies
Self-Referrers & Family
You don't need a referral from a doctor or professional to access most of our services. If you or someone you care about needs support, you can refer directly.
- Individuals seeking lifestyle or disability support
- Parents or carers of children and young people
- Family members seeking support for a loved one
- Older people looking for social connection or activities
- Anyone experiencing hardship or crisis
- Carers seeking support for themselves
What happens after you submit
We aim to make the referral process as straightforward as possible — for the person referring and for the person being referred.
Submit the form
Complete the referral form below with as much detail as you can. All fields marked with an asterisk are required.
We review your referral
Our team reviews every referral within 2 business days and matches it to the most appropriate staff member or program.
We make contact
A team member reaches out to the person being referred (or their carer/guardian) to introduce our services and discuss next steps.
Support begins
We work together to create an individualised plan that meets the person's goals, needs and preferences at their own pace.
Important information
Privacy & Consent
When referring someone other than yourself, please ensure you have their consent — or the consent of their parent or guardian — before submitting personal information. Mossman Support Services handles all personal information in accordance with the Privacy Act 1988 and our Privacy Policy.
In a Crisis or Emergency?
This form is not monitored in real time and is not suitable for crisis situations. If someone is in immediate danger, call 000. For mental health crisis support, call Lifeline on 13 11 14. For our Emergency Relief program, visit us in person at 20 Mill St, Mossman — Monday & Wednesday, 9:45am–11:45am.
What to Have Ready
To complete this referral you will need the person's full name, date of birth, contact details, and a brief description of their support needs. For NDIS referrals, please have their NDIS number and plan dates available if possible.
Prefer to Speak to Someone?
If you would prefer to make a referral by phone, or if you have questions before submitting, our team is happy to help. Call us on (07) 4098 2836 Monday to Friday, 8:30am – 4:30pm, or email manager@dscsa.org.au.
Language Support
If English is not your first language, or if you require an interpreter, please contact us by phone and we can arrange assistance. You can also contact the Translating and Interpreting Service (TIS National) on 131 450 to speak with us through an interpreter.
Accessibility
If you need this form in a different format — such as large print, audio or an Easy Read version — please contact us and we will do our best to assist. Our office at 20 Mill St, Mossman is accessible. View our full Accessibility Statement.
Make a referral
Fill in as much detail as you can. The more information you provide, the better we can match the person to the right program and staff member.
Having trouble with the form?
Call us on (07) 4098 2836 or email manager@dscsa.org.au — Mon to Fri, 8:30am–4:30pm.