Whanau Collective

Home Request Help Professional Referral Admin

Professional Referral

Refer a whanau member for support

Use this form when you're a social worker, navigator, health professional, or agency referring on behalf of a whanau member. The client must consent to this referral.

I need help myself I'm referring someone

Your Details (Referrer)

Your name *

Your role

Agency / Organisation *

Email *

Phone

Client Details

Client name *

Client phone

Client email

Client region *

Referral Details

Support needs *

Housing Mental Health Addiction Family Violence Financial Support Employment Education Health / Hauora Legal Parenting Cultural Support Other

Urgency level *

Low Medium High Critical

Referral notes

Additional description

Client Consent

I confirm the client has given informed consent for this referral. Their information will be shared with the Whanau Collective team to provide appropriate support services. Data is stored securely in Aotearoa.

Whanau Collective — Case management built for Aotearoa. Powered by Polsia